When it comes to prevention of substance use in our “tween” population, turning kids on to ‘thought control’ may just be the answer to getting them to say no, Medical News Today reports.

New research published in the Journal of Studies on Alcohol and Drugs, co-led by professors Roisin O’Connor of Concordia University and Craig Colder of State University of New York at Buffalo, has found that around the” tween-age” years, youth are decidedly ambivalent toward cigarettes and alcohol. It seems that the youngsters have both positive and negative associations with these harmful substances and have yet to decide one way or the other. Because they are especially susceptible to social influences, media portrayals of drug use and peer pressure become strong allies of substance use around these formative years.

“Initiation and escalation of alcohol and cigarette use occurring during late childhood and adolescence makes this an important developmental period to examine precursors of substance use,” O’Connor said. “We conducted this study to have a better understanding of what puts this group at risk for initiating substance use so we can be more proactive with prevention.”

The study showed that at the impulsive, automatic level, these kids thought these substances were bad but they were easily able to overcome these biases and think of them as good when asked to place them with positive words. O’Connor explains that “this suggests that this age group may be somewhat ambivalent about drinking and smoking. We need to be concerned when kids are ambivalent because this is when they may be more easily swayed by social influences.”

According to O’Connor, drinking and smoking among this age group is influenced by both impulsive (acting without thinking), and controlled (weighing the pros against the cons) decisional processes. With this study, both processes were therefore examined to best understand the risk for initiating substance use.

To do this, close to 400 children between the ages of 10 and 12 participated in a computer-based test that involved targeted tasks. The tweens were asked to place pictures of cigarettes and alcohol with negative or positive words. The correct categorization of some trials, for example, involved placing pictures of alcohol with a positive word in one category and placing pictures of alcohol with negative words in another category.

The next step in the study is to look at kids over a longer period of time. The hypothesis from the research is that as tweens begin to use these substances there will be an apparent weakening in their negative biases toward drinking and smoking. The desire will eventually outweigh the costs. It is also expected that they will continue to easily outweigh the pros relative to the cons related to substance use.

O’Connor said researchers would like to continue to track the youth, who, he said, know that drugs are inherently bad.

“The problem is the likelihood of external pressures that are pushing them past their ambivalence so that they use. In a school curriculum format I see helping kids deal with their ambivalence in the moment when faced with the choice to use or not use substances,” O’Connor concluded.

Source:www.cadca.org 15th March 2012

• Young people in the UK have by far the most positive expectations of alcohol in Europe and are least likely to feel that it might cause them harm.
• Exposure to alcohol marketing increases the likelihood that young people will start to use alcohol and the amount they consume.
• The alcohol industry spends £800 million on marketing in the UK annually
• A spends £153 encouraging drinking per £1 contributed to Drinkaware – the industry led alcohol information organisation charged with promoting sensible drinking.
• Underage drinkers consume approximately the equivalent of 6.9 million pints of beer or 1.7 million bottles each week
• 630,000 11- to 17-year-olds drink twice or more each week.
• Between 2002 and 2009 – 92,220 under-18s were admitted to hospital in England for alcohol-related conditions- over 36 children or young people each day.
• Under-18s alcohol-related hospital admissions increased by 32% between 2002 and 2007.
• The latest European School Survey Project on Alcohol and Other Drugs reported that in the UK 26% of 11-15 year-olds reported suffering an accident or injury because of their drinking, the highest percentage in Europe.
• Although cases of dependence amongst underage drinkers are rare, in 2008/9 – 8,799 younger people accessed treatment for alcohol up from 4,886 in 2005/6.

Source:www.alcoholconcern.org.uk Nov.2011

Position Statement – December 2011

The flawed proposition of drug legalisation

Various well funded pressure groups have mounted campaigns to overturn the United Nations Conventions on drugs. These groups claim that society should accept the fact of drugs as a problem that will remain and, therefore, should be managed in a way that would enable millions of people to take advantage of an alleged ‘legal right’ to use drugs of their choice.

It is important to note that international law makes a distinction between “hard law” and “soft law.” Hard law is legally binding upon the States. Soft law is not binding. UN Conventions, such as the Conventions on Drugs, are considered hard law and must be upheld by the countries that have ratified the UN Drug Conventions.

International narcotics legislation is mainly made up of the three UN Conventions from 1961 (Single Convention on Narcotic Drugs), 1971 (Convention on Psychotropic Substances), and 1988 (Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances):

• The 1961 Convention sets out that “the possession, use, trade in, distribution,import, export, manufacture and the production of drugs is exclusively limited to medical and scientific purposes”. Penal cooperation is to be established so as to ensure that drugs are only used licitly (for prescribed medical purposes).

• The 1971 Convention resembles closely the 1961 Convention, whilst
establishing an international control system for Psychotropic Substances.

• The 1988 Convention reflects the response of the international community to increasing illicit cultivation, production, manufacture, and trafficking activities. International narcotics legislation draws a line between licit (medical) and illicit (non-medical) use, and sets out measures for prevention of illicit use, including penal measures. The preamble to the 1961 Convention states that the parties to the Convention are “Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind”. The Conventions are reviewed every ten years and have consistently been upheld.

The UN system of drug control includes the Office of Drugs and Crime, the International Narcotics Control Board, and the Commission on Narcotic Drugs. The works of these bodies are positive and essential in international drug demand and supply reduction. They are also attacked by those seeking to legalise drugs.

It is frequently and falsely asserted that the so-called “War on Drugs” is inappropriate and has become a very costly and demonstrable failure. It is declared by some that vast resources have been poured into the prevention of drug use and the suppression of illicit manufacturing, trafficking, and supply. It is further claimed that what is essentially a chronic medical problem has been turned into a criminal justice issue with inappropriate remedies that make “innocent” people criminals. In short, the flawed argument is that “prohibition” monies have been wasted and the immeasurable financial resources applied to this activity would be better spent for the general benefit of the community.

The groups supporting legalisation are: people who use drugs, those who believe that the present system of control does more harm than good, and those who are keen to make significant profits from marketing newly authorised addictive substances. In addition to pernicious distribution of drugs, dealers circulate specious and misleading information. They foster the erroneous belief that drugs are harmless, thus adding to even more confused thinking.

Superficially crafted, yet pseudo-persuasive arguments are put forward that can be accepted by many concerned, well intentioned people who have neither the time nor the knowledge to research the matter thoroughly, but accept them in good faith. Frequently high profile people claim that legalisation is the best way of addressing a major social problem without cogent supporting evidence. This too influences others, especially the ill informed who accept statements as being accurate and well informed. Through this ill-informed propaganda, people are asked to believe that such action would defeat the traffickers, take the profit out of the drug trade and solve the drug problem completely.

The total case for legalisation seems to be based on the assertion that the government assault on alleged civil liberties has been disastrously and expensively ineffective and counter-productive. In short, it is alleged, in contradiction to evidence, that prohibition has produced more costs than benefits and, therefore, the use of drugs on a personal basis should be permitted. Advocates claim that legalisation would eliminate the massive expenditure incurred by prohibition and would take the profit out of crime for suppliers and dealers. They further claim that it would decriminalise what they consider “understandable” human behaviour and thus prevent the overburdening of the criminal justice system that is manifestly failing to cope. It is further argued irrationally that police time would not be wasted on minor drug offences, the courts would be freed from the backlog of trivial cases and the prisons would not be used as warehouses for those who choose to use drugs, and the saved resources could be used more effectively.

Types of drug legalisation

The term “legalisation” can have any one of the following meanings:

1. Total Legalisation – All illicit drugs such as heroin, cocaine, methamphetamine, and marijuana would be legal and treated as commercial products. No government regulation would be required to oversee production, marketing, or distribution.

2. Regulated Legalisation – The production and distribution of drugs would be regulated by the government with limits on amounts that can be purchased and the age of purchasers. There would be no criminal or civil sanctions for possessing, manufacturing, or distributing drugs unless these actions violated the regulatory system. Drug sales could be taxed.

3. Decriminalisation – Decriminalisation eliminates criminal sanctions for drug use and provides civil sanctions for possession of drugs. To achieve the agenda of drug legalisation, advocates argue for:

• legalising drugs by lowering or ending penalties for drug possession and use – particularly marijuana;

• legalising marijuana and other illicit drugs as a so-called medicine;
• harm reduction programmes such as needle exchange programmes, drug injection sites, heroin distribution to addicts, and facilitation of so-called safe use of drugs that normalize drug use, create the illusion that drugs can be used safely if one just knows how, and eliminates a goal of abstinence from drugs;

• legalised growing of industrial hemp;
• an inclusion of drug users as equal partners in establishing and enforcing drug policy; and

• protection for drug users at the expense and to the detriment of non-users under the pretence of “human rights.”

The problem is with the drugs and not the drug policies

Legalisation of current illicit drugs, including marijuana, is not a viable solution to the global drug problem and would actually exacerbate the problem. The UN Drug Conventions were adopted because of the recognition by the international community that drugs are an enormous social problem and that the trade adversely affects the global economy and the viability of some countries that have become transit routes.

The huge sums of illegal money generated by the drug trade encourage money laundering and have become inextricably linked with other international organised criminal activities such as terrorism, human trafficking, prostitution and the arms trade. Drug Lords have subverted the democratic governments of some countries to the great detriment of law abiding citizens.

Drug abuse has had a major adverse effect on global health and the spread of communicable diseases such as AIDS/HIV. Control is vitally important for the protection of communities against these problems. There is international agreement in the UN Conventions that drugs should be produced legally under strict supervision to ensure adequate supplies only for medical and research purposes. The cumulative effects of prohibition and interdiction combined with education and treatment during 100 years of international drug control have had a significant impact in stemming the drug problem. Control is working and one can only imagine how much worse the problem would have become without it. For instance:

• In 2007, drug control had reduced the global opium supply to one-third the level in 1907 and even though current reports indicate recent increased cultivation in Afghanistan and production in Southeast Asia, overall production has not increased.

• During the last decade, world output of cocaine and amphetamines has stabilized; cannabis output has declined since 2004; and opium production has declined since 2008. We, therefore, strongly urge nations to uphold and enhance current efforts to prevent the use, cultivation, production, traffic, and sale of illegal drugs. We further urge our leaders to reject the legalisation of currently illicit drugs as an acceptable solution to the world’s drug problem because of the following reasons:

• Only 6.1% of people globally between the ages of 15 and 64 use drugs (World Drug Report 2011 UNODC) and there is little public support for the legalisation of highly dangerous substances. Prohibition has ensured that the total number of users is low because legal sanctions do influence people’s behaviour.

• There is a specific obligation to protect children from the harms of drugs, as is
evidenced through the ratification by the majority of United Nations Member States of the UN Convention on the Rights of the Child (CRC). Article 33 states that Member States “shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances”.

• Legalisation sends the dangerous tacit message of approval, that drug use is
acceptable and cannot be very harmful.

• Permissibility, availability and accessibility of dangerous drugs will result in
increased consumption by many who otherwise would not consider using them.

• Enforcement of laws creates risks that discourage drug use. Laws clearly define what is legal and illegal and emphasise the boundaries.

• Legalisation would increase the risks to individuals, families, communities and world regions without any compensating benefits.

• Legalisation would remove the social sanctions normally supported by a legal system and expose people to additional risk, especially the young and vulnerable.

• The legalisation of drugs would lead inevitably to a greater number of dependencies and addictions likely to match the levels of licit addictive substances. In turn, this would lead to increasing related morbidity and mortality, the spread of communicable diseases such as AIDS/HIV and the other blood borne viruses exacerbated by the sharing of needles and drugs paraphernalia, and an increased burden on the health and social services.

• There would be no diminution in criminal justice costs as, contrary to the view held by those who support legalisation, crime would not be eliminated or reduced. Dependency often brings with it dysfunctional families together with increased domestic child abuse.

• There will be increases in drugged driving and industrial accidents.

• Drug Control is a safeguard protecting millions from the effects of drug abuse and addiction particularly, but not exclusively, in developing countries.

• Statements about taxation offsetting any additional costs are demonstrably flawed and this has been shown in the case of alcohol and tobacco taxes. Short of governments distributing free drugs, those who commit crime now to obtain them would continue to do so if they became legal.

• Legalisation would not take the profit out of the drug trade as criminals will always find ways of countering legislation. They would continue their dangerous activities including cutting drugs with harmful substances to maximise sales and profits. Aggressive marketing techniques, designed to promote increased sales and use, would be applied rigorously to devastating effect.

• Other ‘legal’ drugs – alcohol and tobacco, are regularly traded on the black market and are an international smuggling problem; an estimated 600 billion cigarettes are smuggled annually (World Drug report 2009). Taxation monies raised from these products go nowhere near addressing consequential costs.

• Many prisons have become incubators for infection and the spread of drug related diseases at great risk to individual prisoners, prison staff and the general public. Failure to eliminate drug use in these institutions exacerbates the problem.

• The prisons are not full of people who have been convicted for mere possession of drugs for personal use. This sanction is usually reserved for dealers and those who commit crime in the furtherance of their possession.

• The claim that alcohol and tobacco may cause more harm than some drugs is not a pharmacokinetics of psychotropic substances suggest that more, not less, control of their access is warranted.

• Research regularly and increasingly demonstrates the harms associated with drug use and misuse. There is uncertainty, yet growing evidence, about the long-term detrimental effects of drug use on the physical, psychological and emotional health of substance users.

• It is inaccurate to suggest that the personal use of drugs has no consequential and damaging effects. Apart from the harm to the individual users, drugs affect others by addiction, violence, criminal behaviour and road accidents. Some drugs remain in the body for long periods and adversely affect performance and behaviour beyond the time of so-called ‘private’ use. Legalisation would not diminish the adverse effects associated with drug misuse such as criminal, irrational and violent behaviour and the mental and physical harm that occurs in many users.

• All drugs can be dangerous including prescription and over the counter medicines if they are taken without attention to medical guidance. Recent research has confirmed just how harmful drug use can be and there is now overwhelming evidence (certainly in the case of cannabis) to make consideration of legalisation irresponsible.

• The toxicity of drugs is not a matter for debate or a vote. People are entitled to their own opinions but not their own facts. Those who advocate freedom of choice cannot create freedom from adverse consequences.

• Drug production causes huge ecological damage and crop erosion in drug producing areas.

• Nearly every nation has signed the UN Conventions on drug control. Any government of signatory countries contemplating legalisation would be in breach of agreements under the UN Conventions which recognise that unity is the best approach to combating the global drug problem. The administrative burden associated with legalisation would become enormous and probably unaffordable to most governments. Legalisation would require a massive government commitment to production, supply, security and a bureaucracy that would necessarily increase the need for the employment at great and unaffordable cost for all of the staff necessary to facilitate that development.

• Any government policy must be motivated by the consideration that it must first do no harm. There is an obligation to protect citizens and the compassionate and sensible method must be to do everything possible to reduce drug dependency and misuse, not to encourage or facilitate it. Any failures in a common approach to a problem would result in a complete breakdown in effectiveness. Differing and fragmented responses to a common predicament are unacceptable for the wellbeing of the international community. It is incumbent on national governments to cooperate in securing the greatest good for the greatest number.

ISSUED this 21st day of December, 2011 by the following groups:
Drug Prevention Network of the Americas (DPNA)
Institute on Global Drug Policy
International Scientific and Medical Forum on Drug Abuse
International Task Force on Strategic Drug Policy
People Against Drug Dependence & Ignorance (PADDI), Nigeria
Europe Against Drugs (EURAD)
World Federation Against Drugs (WFAD)
Peoples Recovery, Empowerment and Development Assistance (PREDA)
Drug Free Scotland

RANCHO CUCAMONGA, CA -  In new survey, 19 percent of teens admit to driving while under influence of marijuana, more than drunk driving. The survey, conducted by Liberty Mutual Insurance and Students Against Destructive Decisions (SADD), found that more teens are driving after smoking weed than after drinking alcohol. Only 13 percent of teens said they have driven after drinking. Read news release, click here.

Source:  paul@drugfreecalifornia.org  Feb.201

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New research suggests that people who smoke and drink heavily are more at risk for oral cancer, the Researchers from King’s College in London, England, found an increase in oral cancer among men and women in their 20s and 30s who smoke and binge drink.

The researchers said that when tobacco smoke combines with alcohol, it produces dangerous levels of cancer-causing chemicals that attack the lining of the mouth.

“Our data show that smoking, drinking and poor diet are major risk factors, and that the younger people start smoking and drinking, the higher the risk,” said Newell Johnson, a professor of oral pathology at King’s College

Source: Daily Telegraph,  London  reported Nov. 9.2004

New research finds there are some genes that affect one but not the other

WEDNESDAY, Aug. 18 (HealthDayNews) — Some people can drink a lot of alcohol without becoming addicted, and specific genes may help explain why, researchers say.

In a new study of Australian twins, scientists found that separate genes appear to be responsible, to some degree, for dependence on alcohol — addiction — and how much people drink. Understanding how these genetic factors work together should give researchers more insight into treatment of alcoholism in its various forms, said study co-author John B. Whitfield, a researcher at Royal Prince Alfred Hospital in Australia.

Alcoholism and alcohol consumption may appear to be similar, but researchers are increasingly studying them separately. Consumption refers to the amount of alcohol that someone drinks, while addiction refers to a person’s inability to go without a drink.

“The transition from social alcohol consumption to alcohol dependence is a gradual process, and it is often hard to notice it,” said Dr. Alexei B. Kampov-Polevoi, an assistant professor of psychiatry at Mount Sinai School of Medicine. “As a result, many alcoholics and their family members continue to think that a person ‘just drinks too much’ while this person already developed alcohol dependence and requires treatment.”

Whitfield and his colleagues examined statistics about alcohol use from three studies of Australian twins completed between 1980 and 1995. The number of twins in the studies declined from 8,184 in 1980 to 3,378 in 1995.
The findings appear in the August issue of Alcoholism: Clinical & Experimental Research.

The researchers found twins who were genetically similar were more likely to consume similar amounts of alcohol. According to the study, some genes affected both addiction and alcohol intake, while some just affected addiction.

“We found (as others have also found) that alcohol dependence is partly, but not entirely, due to genetic differences between people who are affected by it and those who are not,” Whitfield said. “We also found that variation in the amount of alcohol that people habitually drink is subject to genetic influence, and that there is some — but not complete — overlap between the genes affecting these two things.”

Howard J. Edenberg, professor of biochemistry and molecular biology at Indiana University, said the findings — that genes separately affect alcoholism and drinking — are “reasonable.” But “that is a long way from identifying individual genes that actually are involved,” said Edenberg, whose own research is looking into that area.

So what should ordinary folks take from this study? “There is no direct and new message for people with alcoholism in their families; they are at higher risk than average but this has been known for some time and there is only a statistical risk, not a certainty by any means,” Whitfield said. “The more positive message for such people, and the community at large, is that we are learning more about alcohol use and alcohol-related problems and their causes.”

Source  By Randy Dotinga
HealthDay Reporter    August  2004

University of Adelaide researchers have found that immune cells in your brain may contribute to how you respond to alcohol. Lead researcher Dr Mark Hutchinson, ARC Research Fellow with the University’s School of Medical Sciences, said his team’s research provided new evidence that an immune response in the brain was involved in behavioural responses to alcohol. This immune response lies behind some of the well-known alcohol-related behavioural changes, such as difficulty controlling the muscles involved in walking and talking.

“It’s amazing to think that despite 10,000 years of using alcohol, and several decades of investigation into the way that alcohol affects the nerve cells in our brain, we are still trying to figure out exactly how it works,” says lead researcher Dr Mark Hutchinson from the University’s School of Medical Sciences.
“Alcohol is consumed annually by two billion people world-wide with its abuse posing a significant health and social problem,” said Dr Hutchinson. “Over 76 million people are diagnosed with an alcohol abuse disorder. “This work has significant implications for our understanding of the way alcohol affects us, as it is both an immunological and neuronal response. Such a shift in mindset has significant implications for identifying individuals who may have bad outcomes after consuming alcohol, and it could lead to a way of detecting people who are at greater risk of developing brain damage after long-term drinking.”

The research is published in the latest edition of the British Journal of Pharmacology by PhD student Yue Wu, supervisor Dr Hutchinson, and others. Laboratory mice were given a single shot of alcohol and the researchers studied the effect of blocking toll-like receptors, a particular element of the immune system, on the behavioural changes induced by alcohol. The researchers studied the effects of blocking the receptors by drugs, and also the effects of giving alcohol to mice that had been genetically altered so that they were lacking the functions of the selected receptors.

“The results showed that blocking this part of the immune system, either with the drug or genetically, reduced the effects of alcohol,” Dr Hutchinson said. He believes similar treatment could work in humans. “Medications targeting this specific receptor ‒ toll-like receptor 4 ‒ may prove beneficial in treating alcohol dependence and acute overdoses,” Dr Hutchinson said.

Source: http://ahha.asn.au/news mark.hutchinson@adelaide. 29th Sept.2011

Children of drug addicts are suffering in desperation as shame and secrecy shroud the substance misuse in families, it was claimed today.

Youngsters whose parents take drugs are also more likely to have problems with substances, as well as their mental health, social skills and academically, a seminar heard. Joan O’Flynn, director of the National Advisory Committee on Drugs (NACD), said there is a need for more integration between addiction services, children’s services and medical professionals.

“Alcohol and drugs misuse by parents can impact negatively on a child’s experience of positive parenting and can create stressful family circumstances that impact on child development,” she said. “For many of the affected children, the effect of their parents’ substance misuse continues into their adult lives.

“For some, the impact can be multifaceted and persist not only into adult life but even into the lives of the next generation.” She added that stress, combined with the increased likelihood of the child being in care or homeless, leaves young people at a high risk of emotional isolation or social marginalisation.

Alcohol Action Ireland estimates between 61,000 and 104,000 children aged under 15 are living with parents who misuse alcohol. Director Fiona Ryan said: “Shame and secrecy shroud the issue of substance misuse in families with children living lives of quiet desperation.

“Alcohol Action Ireland has spent the past three years campaigning for children affected by parental alcohol problems to be seen and heard.” An NACD report – ‘Parental Substance Misuse: Addressing its Impact on Children’ – was launched at a seminar it jointly hosted with the Health Service Executive (HSE) and Alcohol Action Ireland, the national charity for alcohol-related issues.

The report reviewed all major international research on the impact of parental substance misuse on children and identified what steps can be taken in Ireland to reduce its impact.

It recommended additional research and data be collected to properly estimate the number of children whose parents have substance misuse problems. It also wants an assessment of which adult alcohol and drug treatment services are supporting parents and liaising with child support services. Women should also be educated on the adverse effects of consuming alcohol and drugs during pregnancy, it added.

Source: www.IrishExaminer.com 26th October 2011

Research Summary

Alcohol consumption prompts the brain to release the pleasure chemical dopamine, but genes may influence the degree to which the brain responds to drinking and — by extension — how effective medications like naltrexone are in treating alcoholism.
Researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that genetic variations in the mu-opioid receptor sites in the brain’s reward system seem to influence the release of the neurotransmitter dopamine and the degree of pleasure that individuals get from drinking.
Researchers also found that naltrexone — a drug that works to block the release of dopamine resulting from drinking — was more effective for patients with some genetic profiles than others.
“Our data strongly support a causal role of the 118G variant of the mu-opioid receptor to confer a more vigorous dopamine response to alcohol in the ventral striatum,” said NIAAA researcher Vijay A. Ramchandani, Ph.D. “The findings add further support to the notion that individuals who possess this receptor variant may experience enhanced pleasurable effects from alcohol that could increase their risk for developing alcohol abuse and dependence. It may also explain why these individuals, once addicted, benefit more from treatment with blockers of endogenous opioids.”
Markus Heilig, NIAAA’s clinical director, noted that naltrexone also worked better in the early stages of alcoholism, when the body still believes it is being rewarded for drinking (‘reward craving’). At a certain point, however, the brain switches to a pattern called ‘relief craving’ — what Heilig called a “pathological pattern of anxiety” — where naltrexone isn’t nearly as helpful.
The latest findings were published online in the journal Molecular Psychiatry.

Source: Join Together May 20, 2010

Hospitalizations for alcohol and drug overdoses – alone or in combination – increased dramatically among 18- to 24-year-olds between 1999 and 2008, according to a study by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

Led by Aaron M. White, Ph.D. and Ralph W. Hingson, Sc.D., of NIAAA’s division of epidemiology and prevention research, the study examined hospitalization data from the Nationwide Inpatient Sample, a project of the U.S. Agency for Healthcare Research and Quality designed to approximate a 20 percent sample of U.S. community hospitals. The findings appear in the September issue of the Journal of Studies on Alcohol and Drugs.

Drs. White, Hingson, and their colleagues report that, over the 10-year study period, hospitalizations among 18-24-year-olds increased by 25 percent for alcohol overdoses; 56 percent for drug overdoses; and 76 percent for combined alcohol and drug overdoses.

“In 2008, 1 out of 3 hospitalizations for overdoses in young adults involved excessive consumption of alcohol,” noted Dr. White. “Alcohol overdoses alone caused 29,000 hospitalizations, combined alcohol and other drug overdoses caused 29,000, and drug overdoses alone caused another 114,000. The cost of these hospitalizations now exceeds $1.2 billion per year just for 18-24-year-olds.”

According to the authors, this is a growing problem for those outside of the 18-24 age range, as well.

“Among the entire population 18 and older, 1.6 million people were hospitalized for overdoses in 2008, at a cost of $15.5 billion, and half of these hospitalizations involved alcohol overdoses,” added Dr. Hingson.
The current study also showed an increase of 122 percent in the rate of poisonings from prescription opioid pain medications and related narcotics among 18-24 year olds. An alcohol overdose was present in 1 of 5 poisonings on these medications.

“The combination of alcohol with narcotic pain medications is particularly dangerous, because they both suppress activity in brain areas that regulate breathing and other vital functions,” Dr. White said.

The researchers noted that the steep rise in combined alcohol and drug overdoses highlights the significant risk and growing threat to public health of combining alcohol with other substances, including prescription medications. They call for stronger efforts to educate medical practitioners and the general public about the dangers of excessive alcohol consumption alone or in combination with other drugs.

“An increase in screening for alcohol misuse would help clinicians identify patients at particularly high risk for excessive drinking and for alcohol and medication interactions,” said NIAAA Acting Director Kenneth Warren, Ph.D. “Clinicians should use brief intervention techniques to help young adults evaluate their relationship with alcohol and other drugs and make wise choices regarding future use

Source www.cadca.org Sept. 2011

Slovenian study identifies which chemicals in the blood best identify dependent drinkers in the sense of not missing those who are dependent, confirming when they have stopped drinking, and not falsely identifying non-dependent people as dependent.

Summary

The aim of this study was to determine the value of biochemical tests for glutamate dehydrogenase (GLDH) in the blood as way of diagnosing alcohol dependence, in particular as compared to or in combination with other biochemical markers including gama-glutamyltransferase (GGT), aspartate-aminotranferase (AST), alanine-aminotransferase (ALT) and erythrocyte mean cell volume (MCV). All these levels were assessed three times in 238 alcohol dependent patients admitted to hospital (on admission, after 24 hours and after seven days) and also in healthy members of the public.
Main findings All the values were significantly higher in the patients than in healthy persons. GLDH exhibited the fastest decrease in levels after the resumption of abstinence. 24 hours of non-drinking is sufficient for a reliable evaluation of the fall in GLDH activity, even more so when alcohol dependants had not drunk for three to seven days, offering a way to confirm the cessation of drinking. The time course of changes in GLDH and AST were more applicable than for GGT after a week, but GLDH changes were most reliable. GLDH was the most specific marker with almost 90% specificity, correctly identifying nine in 10 of the healthy subjects as non-dependent. A decision tree combining MCV,
GGT and GLDH markers was selected as the best diagnostic procedure because of its simplicity, easy examination and moderate cost. It gave a model with 84.5% accuracy, excellent specificity at 90% (correctly identifying 9 in 10 healthy subjects as non-dependent) and very high sensitivity at almost 80% (correctly identifying 8 in 10 alcohol dependent patients as dependent).

Conclusions

The high accuracy of our classification model provides an opportunity to apply it as a helping method in finding and diagnosing alcohol dependence in everyday practice, with our exclusion criteria and differential diagnostic cautions taken into consideration. We strongly believe that watching changes in the activity of laboratory markers of alcoholism is an effective yet overlooked aid.
Thanks for their comments on this entry in draft to Matej Kravos of the Psychiatric Hospital Ormoz in Slovenia. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Source: Kravos M., Malešic I.
Alcohol and Alcoholism: 2010, 45(1), p. 39–44. Revised 22 Aug.2011

The percentage of fatally injured drivers testing positive for drugs increased over the last five years, according to data from the National Highway Traffic Safety Administration (NHTSA). Each year between 56% and 65% of drivers fatally injured in motor vehicle crashes were tested for the presence of drugs in their systems. In 2009, 33% of the 12,055 of drivers fatally injured in motor vehicle crashes with known test results tested positive* for at least one drug, compared to 28% in 2005 (see figure below). The drugs tested for included both illegal substances as well as over-the counter and prescription medications, (which may or may not have been misused). In 2009, marijuana was the most prevalent drug found in this population—approximately 28% of fatally injured drivers who tested positive were positive for marijuana1. The authors caution that “drug involvement rates among those with unavailable drug test results may be similar to those for whom results are available, or there may be a systematic bias that could influence the unavailable rates in a positive or negative direction.”

*Nicotine, aspirin, alcohol, and drugs administered after the crash are excluded. Testing positive for drugs only means that the drugs were found in the driver’s system and does not imply impairment or indicate that drug use was the cause of the crash or the fatality.

SOURCE: Adapted by CESAR from National Highway Traffic Safety Administration (NHTSA),
drug Involvement of Fatally Injured Drivers,” Traffic Safety Facts, November 2010.
Available online at http://www-nrd.nhtsa.dot.gov/Pubs/811415.pdf

This week, The National Center on Addiction and Substance Abuse at Columbia University released the National Survey of American Attitudes on Substance Abuse XVI: Teens and Parents. This year’s survey reveals that teens who regularly use social networking sites are at increased risk of smoking, drinking and using drugs. The survey finds that compared to teens who in a typical day do not spend any time on a social networking site, those who do are five times likelier to use tobacco, three times likelier to use alcohol, and twice as likely to use marijuana.

The CASA Columbia survey also reveals that 40 percent of all teens surveyed have seen pictures on Facebook, Myspace or other social networking sites of kids getting drunk, passed out, or using drugs and kids who have seen such pictures at also at increased substance abuse risk.

This year’s survey explored teen TV viewing habits in relation to teen substance abuse and found that compared to teens that do not watch suggestive teen programming, those who do are likelier to smoke, drink and use drugs.

According to Joseph A. Califano, Jr., CASA Columbia’s Founder and Chairman and Former U.S. Secretary for Health, Education, and Welfare: “The relationship of social networking site images of kids drunk, passed out, or using drugs and of suggestive teen programming to increased teen risk of substance abuse offers grotesque confirmation of the adage that a picture is worth a thousand words. The time has come for those who operate and profit from social networking sites like Facebook to deploy their technological expertise to curb such images and to deny use of their sites to children and teens who post pictures of themselves and their friends drunk, passed out or using drugs. Continuing to provide the electronic vehicle for transmitting such images constitutes electronic child abuse.”
Source: www.CADCA.org Aug. 2011

In this Dutch study, promoting parental rule setting and classroom alcohol education together nearly halved the proportion of adolescents who went on to drink heavily. Rarely have such strong and sustained drinking prevention impacts been recorded from these types of interventions.

Summary

This Dutch study tested the long-term impact of the Örebro intervention (first developed and tested in Sweden) targeting parental rule-setting in relation to the drinking of their adolescent children, allied with classroom alcohol education. The parenting element entailed a brief presentation from an alcohol expert at the first parents’ meeting at the start of each school year on the adverse effects of youth drinking and the negative effects of permissive parental attitudes towards children’s alcohol use. After this parents of children from the same class were meant to meet to agree a shared set of rules about alcohol use. In fact, only half the schools did this; the remainder used the later mailing to send a checklist of candidate rules to parents for them to select from and return to the school. Three weeks after this meeting, a summary of the presentation and the result of the classroom discussion was sent to parents’ home addresses. Classroom alcohol education consisted of four lessons from trained teachers at the schools plus a booster a year later, using mainly computerised modules to foster a healthy attitude to drinking and to train the pupils in how to refuse offers of alcohol.
The 19 schools which joined the study were randomly allocated to the parenting intervention alone, to classroom alcohol education alone, to the combination of both, or to act as control schools which carried on with alcohol education as usual.
An earlier paper from the same study reported that relative to education as usual, among the 2937 (of 3490) 12–13-year-olds not already drinking weekly and who met other criteria for the study, the combined parenting and education intervention curbed the initiation of weekly drinking and heavy weekly drinking over the next 22 months (and reduced the frequency of drinking). In contrast, on their own, neither the parenting elements nor the lessons made any significant difference when the whole sample of children not yet drinking weekly at the start were included in the analyses.

Main findings

The featured report tested whether these effects were still apparent a year later, 34 months after the start of the study and when the pupils averaged just over 15 years of age, a time when two thirds of Dutch youngsters are already drinking weekly and will soon (age 16) be able to legally buy alcohol. Of the 2937 in the initial sample of non-weekly drinkers, 2533 (86%) completed the follow-up assessment. The probable responses of the remainder were estimated on the basis of prior assessments and other data. As before, the parenting elements or alcohol education alone had made no statistically significant differences to drinking, but the impacts of both together in retarding uptake of weekly and heavy weekly drinking were greater than a year before chart. Compared to 59% and 27% in education-as-usual control schools, after the combined intervention 49% and 15% of pupils were drinking weekly or drinking heavily each week. After adjusting for other factors, the results meant that in combined intervention schools, the odds of these patterns of drinking versus less extreme drinking had been reduced to 0.69 relative to education as usual, highly statistically significant findings. Put another way, for every four pupils allocated to parenting plus alcohol education, one was prevented from drinking weekly and also one from drinking heavily each week at age 15.

The authors’ conclusions

In a liberal drinking culture where adolescent and underage drinking is common, targeting both parents and young adolescent pupils (but not either on their own) exercises a sustained and substantial restraining influence on the development of regular and regular heavy drinking as the youngsters approach the legal alcohol purchase age. The findings underline the need to target adolescents as well as their parents and of targeting adolescents at an early age, before they start to drink regularly and when family factors are a major influence on youth drinking. Doing so has the potential to create appreciable public health gains.

Source: Koning I.M., van den Eijnden R.J., Verdurmen J.E. et al.
American Journal of Preventive Medicine: 2011, 40(5), p. 541–547.

Researchers from the Medical Research Council (MRC) have uncovered for the first time how excess alcohol can cause irreparable damage to our DNA. In a new study published in the journal Nature today, MRC scientists also discovered a two-tier defence system in our cells that limits the threat of permanent genetic damage.
Scientists at the MRC’s Laboratory of Molecular Biology (LMB) have discovered that an overload of a toxic chemical called acetaldehyde, a by-product from the breakdown of alcohol in our body, can cause damage to DNA. They showed that our cells have two natural ways of protecting us against acetaldehyde. Firstly, this toxin can be removed by specialised enzymes. If this step fails, acetaldehyde builds up and damages DNA, but a second mechanism kicks in to repair the damaged DNA, using another set of enzymes known as the Fanconi proteins.
In pregnant mice which were genetically altered not to have these two defences, the equivalent of a single binge drinking session of alcohol caused catastrophic damage to the fetus. Not only did alcohol damage the fetus, but in the adult modified mice, this alcohol consumption damaged blood stem cells, obliterating the production of blood.
Dr KJ Patel, lead author of the paper from the MRC Laboratory of Molecular Biology, said:
“The findings show how critically reliant we are on both these control systems to prevent alcohol from causing irreversible mutations to DNA, both in the fetus and in our own cells.
“The effects of alcohol in the modified pregnant mice resembled fetal alcohol syndrome, where excessive drinking by pregnant women causes permanent damage to the unborn child, leading to birth defects and learning difficulties. Our work suggests that binge drinking could generate enough acetaldehyde to overwhelm the body’s two natural defence mechanisms.
“This new knowledge transforms our view of precisely how excess alcohol causes damage – ultimately changing our DNA. Quite apart from this, our conclusions suggest potentially simple approaches to treat Fanconi anaemia – currently a terminal incurable illness in humans.”
The study highlights how two groups who have inherited failures of the natural control mechanisms are particularly at risk of severe DNA damage from alcohol. Individuals with a rare disease called Fanconi anaemia, which affects around 20,000 people worldwide, do not have the enzymes which repair DNA and are likely to be very sensitive to acetaldehyde. This could explain why such people are highly susceptible to both blood disorders and cancer. More commonly, around 500 million people from South East Asia with a condition called the ‘Asian alcohol flushing mutation’ have a greatly reduced capacity to break down acetaldehyde. This research suggests these individuals may be susceptible to lifelong DNA damage and could explain why alcohol consumption greatly increases their risk of gullet cancer.
Dr Hugh Pelham, director of the MRC Laboratory of Molecular Biology, said:
“We know that there’s a complex interplay between genetics, our body’s natural resilience to disease and our environment. By determining the molecular reason behind the toxic effects of alcohol to our DNA, our researchers have shown how vulnerable we can be to DNA damage from excess alcohol and even more so in the womb. Despite the existence of protective mechanisms, long-term genetic damage must be added to the risks of excessive alcohol consumption.”
The research was also funded by the Children’s Leukaemia Trust UK and the Fanconi Anaemia Research Fund USA.

Source: www.mrc.ac.uk 6th July 2011

Finding could lead to development of drugs that decrease heavy alcohol consumption.

A team of Scripps Research Institute scientists has found a key biological mechanism underpinning the transition to alcohol dependence. This finding opens the door to the development of drugs to manage excessive alcohol consumption.
“Our focus in this study, like much of our lab’s research, was to examine the role of the brain’s stress system in compulsive alcohol drinking driven by the aversive aspects of alcohol withdrawal,” said Scripps Research Associate Professor Marisa Roberto, Ph.D., senior author of the study.
“A major goal for this study,” added Research Associate Nicholas Gilpin, Ph.D., the paper’s first author, “was to determine the neural circuitry that mediates the transition to alcohol dependence.”
In the new research, published in the June 1, 2011 issue of the journal Biological Psychiatry, the Scripps Research scientists demonstrated the key role of a receptor —a structure that binds substances, triggering certain biological effects—for neuropeptide Y in a part of the brain known as the central amygdala. The amygdala, a group of nuclei deep within the medial temporal lobes, performs an important role in the processing and memory of emotional reactions.
“We’ve known for quite some time that neuropeptide Y is an endogenous [naturally occurring] anti-stress agent,” says Markus Heilig, clinical director of the National Institute of Alcohol Abuse and Alcoholism (NIAAA). “We’ve also known that development of alcohol dependence gives rise to increased sensitivity to stress. This paper elegantly and logically brings these two lines of research together. It supports the idea that strengthening neuropeptide Y transmission in the amygdala would be an attractive treatment for alcoholism. The challenge remains to develop clinically useful medications based on this principle.”
Discovering the Circuitry
Building on Gilpin’s previous work on neuropeptide Y, in the new project, Gilpin, Roberto, and colleagues observed the effects of the administration neuropeptide Y in the central amygdala on alcohol drinking in rats. Alcohol-dependent rats were allowed to press levers for ethanol and water during daily withdrawal from chronic alcohol exposure.
“Normally, the transition to alcohol dependence is accompanied by gradually escalating levels of alcohol consumption during daily withdrawals,” Gilpin explained. “The aim of this protocol was to examine whether neuropeptide Y infusions during daily withdrawals would block this escalation of alcohol drinking.”
The scientists report a suppression of alcohol consumption with chronic neuropeptide Y infusions and detailed some of the neurocircuitry involved. Ethanol normally produces robust increases in inhibitory GABAergic transmission—GABA is another neurotransmitter—in the central amygdala, but this effect is blocked and reversed by neuropeptide Y.
Gilpin notes the scientists were surprised at one aspect of the findings—the role of a subset of neuropeptide Y receptors known as Y2 receptors. “Previous behavioral evidence suggested that antagonism of Y2 receptors in whole brain suppresses alcohol drinking, similar to the effects of neuropeptide Y,” he said. “However, our data suggest that Y2 receptor blockade in central amygdala might actually increase alcohol drinking, presumably by affecting pre-synaptic release of GABA. These data also suggest that antagonism of post-synaptic Y1 receptors in central amygdala provides a viable pharmacotherapeutic strategy, a hypothesis supported by previous work from other labs.”
Two additional aspects of the findings are worth noting, Roberto says. First, repeated neuropeptide Y administration not only blocked the development of excessive alcohol consumption in dependent rats, but also tempered the moderate increase in alcohol consumption following periods of abstinence in non-dependent rats. Second, neuropeptide Y exhibited long-term efficacy in suppressing alcohol self-administration, highlighting the potential of neuropeptide Y treatments for a clinical setting.

Source: “Neuropeptide Y Opposes Alcohol Effects on GABA Release in Amygdala and Blocks the Transition to Alcohol Dependence” June 1, 2011 print edition of Biological Psychiatry. See http://www.ncbi.nlm.nih.gov/pubmed/21459365

Abstract

OBJECTIVE:

Moderate to heavy levels of prenatal alcohol exposure have been associated with alterations in child behavior, but limited data are available on adverse effects after low levels of exposure. The objective of this study was to evaluate the dose-response effect of prenatal alcohol exposure for adverse child behavior outcomes at 6 to 7 years of age.

METHODS:

Beginning in 1986, women attending the urban university-based maternity clinic were routinely screened at their first prenatal visit for alcohol and drug use by trained research assistants from the Fetal Alcohol Research Center. All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5% random sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development. Maternal alcohol, cigarette, and illicit drug use were prospectively assessed during pregnancy and postnatally. The independent variable in this study, prenatal alcohol exposure, was computed as the average absolute alcohol intake (oz) per day across pregnancy. At each prenatal visit, mothers were interviewed about alcohol use during the previous 2 weeks. Quantities and types of alcohol consumed were converted to fluid ounces of absolute alcohol and averaged across visits to generate a summary measure of alcohol exposure throughout pregnancy. Alcohol was initially used as a dichotomous variable comparing children with no prenatal alcohol exposure to children with any exposure. To evaluate the effects of different levels of exposure, the average absolute alcohol intake was relatively arbitrarily categorized into no, low (>0 but <0.3 fl oz of absolute alcohol/day), and moderate/heavy (>/=0.3 fl oz of absolute alcohol/day) for the purpose of this study. Six years later, 665 families were contacted. Ninety-four percent agreed to testing. Exclusions included children who missed multiple test appointments, had major congenital malformations (other than fetal alcohol syndrome), possessed an IQ >2 standard deviations from the sample mean, or had incomplete data. The Achenbach Child Behavior Checklist (CBCL) was used to assess child behavior. The CBCL is a parent questionnaire applicable to children ages 4 to 16 years. It is widely used in the clinical assessment of children’s behavior problems and has been extensively used in research. Eight syndrome scales are further grouped into Externalizing or undercontrolled (Aggressive and Delinquent) behavior and Internalizing or overcontrolled (Anxious/Depressed, Somatic Complaints, and Withdrawn) behaviors. Three syndromes (Social, Thought, and Attention Problems) fit neither group. Higher scores are associated with more problem behaviors. Research assistants who were trained and blinded to exposure status independently interviewed the child and caretaker. Data were collected on a broad range of control variables known to influence childhood behavior and/or to be associated with prenatal alcohol exposure. These included perinatal factors of maternal age, education, cigarette, cocaine, and other substances of abuse and the gestational age of the baby. Postnatal factors studied included maternal psychopathology, continuing alcohol and drug use, family structure, socioeconomic status, children’s whole blood lead level, and exposure to violence. Data were collected only from black women as there was inadequate representation of other racial groups.

STATISTICAL ANALYSES:

Statistical analyses were performed using the SPSS statistical package. Frequency distribution, cross-tabulation, odds ratio, and chi(2) tests were used for analyzing categorical data. Continuous data were analyzed using t tests, analyses of variance (ANOVAs) with posthoc tests, and regression analysis.

RESULTS:

Testing was available for 501 parent-children dyads. Almost one fourth of the women denied alcohol use during pregnancy. Low levels of alcohol use were reported in 63.8% and moderate/heavy use in 13% of pregnancies. Increasing prenatal alcohol exposure was associated with lower birth weight and gestational age, higher lead levels, higher maternal age, and lower education level, prenatal exposure to cocaine and smoking, custody changes, lower socioeconomic status, and paternal drinking and drug use at the time of pregnancy. Children with any prenatal alcohol exposure were more likely to have higher CBCL scores on Externalizing (Aggressive and Delinquent) and Internalizing (Anxious/Depressed and Withdrawn) syndrome scales and the Total Problem Score. The odds ratio of scoring in the clinical range for Delinquent behavior was 3.2 (1.3-7.6) in children with any prenatal exposure to alcohol compared with nonexposed controls. The threshold dose was evaluated with the 3 prenatal alcohol exposure groups. One-way ANOVA revealed a significant between group difference for Externalizing (Aggressive and Delinquent) and the Total Problem Score

Source: Pediatrics. 2001 Aug;108(2):E34.PMID: 11483844 [PubMed - indexed for MEDLINE]

Reports that school prevention programs aimed at curbing alcohol misuse in children are somewhat helpful, enough so to deserve consideration for widespread use, according to a large, international systematic review.

The most significant program effects were reductions in episodes of drunkenness and binge drinking, reviewers found.

“School-based prevention programs that take a social skills-oriented approach or that focus on classroom behavior management can work to reduce alcohol problems in young people,” David Foxcroft, lead review author said. “However, there is good evidence that these sorts of approaches are not always effective.”

The reasons for inconsistent results with these programs are unclear, said Foxcroft, from Great Britain’s Oxford Brookes University.

Foxcroft and co-author Alexander Tsertsvadze, at the University of Ottawa Evidence-Based Practice Center, in Canada, analyzed 53 randomized controlled trials done in a wide range of countries with youth ages 5 to 18 when studies began.

Forty-one studies took place in North America, six in Europe and six in Australia. One was conducted in India and one in Swaziland. Two studies transpired in multiple locations.

Most studies assessed generic prevention programs that targeted several risky behaviors, such as drinking, smoking and drug abuse, while the rest focused on alcohol-specific programs.

The researchers compared drinking among the youngsters who took part in various school-based programs to the drinking done by students who were not. The youngsters in the comparison groups might have participated in other alcohol-prevention programs, such as family-based ones, or they might have just experienced the ordinary school curriculum.

The authors concluded that their evidence supported the use of certain generic prevention programs over alcohol-specific ones. They cited the Life Skills Training Program, the Unplugged Program and the Good Behavior Game as particularly effective interventions.

The review appears in the May 2011 issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“These findings are important,” David Jernigan, Ph.D., director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health, said. “Efforts to reduce young people’s drinking through school-based programs are legion. A $300 million federal program supporting school-based prevention ended last year, partly based on research findings that these programs do not work. This review does not find that. Instead it indicates that there is something in certain school-based programs that in fact can work.”

Jernigan emphasizes that “school-based programs are so often expected to do the whole job of prevention, and this is an unfair expectation.” He describes school-based programs functioning as “lonely voices” in an environment saturated with marketing messages promoting youthful drinking. The amount of drinking in a youngster’s home and community and the price of alcohol are other major influences that need addressing, he said. Until then, “we can’t expect large effects from school-based programs alone.”

Health Behavior News Service is part of the Center for Advancing Health.

Source: www.cadca.org 12th May 2011

May 2, 2011

CANCER COUNCIL AUSTRALIA has revised dramatically upwards its estimate of alcohol’s contribution to new cancer cases and issued its strongest warning yet that people worried by the link should avoid drinking altogether.
New evidence implicating alcohol in the development of bowel and breast cancer meant drinking probably caused about 5.6 per cent of cancers in Australia, or nearly 6500 of the 115,000 cases expected this year, a review by the council found. This was nearly double the 3.1 per cent figure it nominated in its last assessment, in 2008.
The council’s chief executive, Ian Olver, said the updated calculations revealed breast and bowel cancer accounted for nearly two-thirds of all alcohol-related cancers, overtaking those of the mouth, throat and oesophagus.
”The public really needs to know about it because it’s a modifiable risk factor,” said Professor Olver, calling for awareness campaigns to alert people to the link. ”You might not be able to help your genes but you can make lifestyle choices.”
Professor Olver said public advice should not conflict with the National Health & Medical Research Council’s 2009 recommendation people should drink no more than two standard alcohol units daily, already half the previous safe threshold for men.
But people should also be told there was no evidence of a safe alcohol dose below which cancer-causing effects did not occur – either from direct DNA damage, increased oestrogen levels or excessive weight gain. ”If you want to reduce your cancer risk as far as possible [abstinence] would be the option you have,” he said.
Public advice was especially important, Professor Olver said, because studies that suggested alcohol could protect against heart disease were increasingly being challenged by new findings that people gave up drinking when they became ill or old – meaning any potential benefits of moderate alcohol use for cardiovascular health had probably been oversold.

Source: : http://www.theage.com.au/lifestyle/wellbeing/quit-drinking-to-cut-cancer-risk-20110501-1e38g.html#ixzz1LTPjlgEi May 2011

Many mothers and fathers think that allowing their children to have a supervised drink is a good way of exposing them to alcohol safely and taking away its illicit thrill. But new research suggests it sends mixed signals that result in them being more likely to abuse alcohol as they enter their core teenage years.
A joint American-Australian study of more than 1,900 12 and 13-year-olds found that those whose parents took such a “harm minimisation” approach were more likely to have experienced “alcohol-related consequences” – such as not being able to stop drinking, getting into fights, or having blackouts – two years later than those whose parents had a “zero-tolerance” strategy.
A year into the study, almost twice as many Australian teenagers (67 per cent) had drunk alcohol in the presence of an adult than their American counterparts (35 per cent), reflecting general attitudes in Australia and the US when it comes to supervised underage drinking.
The following year, just over a third (36 per cent) of the Australians had experienced alcohol-related consequences compared to only a fifth (21 per cent) of the Americans.
While cultural differences alone could feasibly account for the disparity, the results also found that teens who had been allowed to drink while supervised were more likely to have had such experiences regardless of which country they were from.
The results of the study, conducted by the Centre for Adolescent Health in Melbourne, Australia, and the Social Development Research Group in Seattle, USA, are published today in the Journal of Studies on Alcohol and Drugs.
British attitudes to teenage drinking are more similar to those in Australia than America, a matter reflected in law. While in the UK and Australia one can buy an alcoholic drink in a pub or off-licence from the age of 18, in the US the minimum age is 21. However, two years ago Sir Liam Donaldson, then England’s chief medical officer, said children under 15 should never be given alcohol, even though it is legal for parents to give a child over five alcohol in the home.
A separate Dutch study of 500 12-to-15-year-olds, also published in the JSAD today, found that it was the amount of alcohol available at home, and not how much parents drank, that determined teenage drinking habits – suggesting parents should keep their drinks cabinets locked.
Dr Barbara McMorris, of Minnesota University, who led the first study, said: “Both studies show that parents matter. “Despite the fact that peers and friends become important influences as adolescents get older, parents still have a big impact.” She added: “Kids need parents to be parents and not drinking buddies. Adults need to be clear about what messages they are sending. Kids need black and white messages early on. “Such messages will help reinforce limits as teens get older and opportunities to drink increase.”

Source: www.telegraph.co.uk/health 28th April 2011

The number of under-16s arriving drunk at accident and emergency inAberdeenhas soared by a shocking 60 per cent.

And health chiefs have warned that more and more vital hospital beds are now being filled up with booze-binge schoolchildren.

Alarming statistics reveal the number of people treated for alcohol-related emergencies by NHS Lothian has soared by 68 per cent.

There were 4,751 cases in 2008/09, up from 2,823 in 2006/07. And inAberdeen, the number has risen from 1,712 people five years ago to 2,220 in 2008/09.

The figure for the same period in Aberdeenshire increased from 900 to 1,051.

The numbers were only topped by Greater Glasgow andClyde, with 13,592 alcohol-related discharges in 2008/09.

Worried politicians last night called for urgent action to tackleScotland’s underage drinking shame.

MSP Murdo Fraser, the Tory shadow health secretary, said: “These are frightening figures that show just how deep the problem is. We have to target problem drinks and problem drinkers, give better education on the dangers of alcohol abuse, and crack down on those who sell to children.”

A Labour spokesman called the new statistics “highly alarming”.

He added: “The SNP Government has to bring forward measures that actually work. They need to crack down on the rogue shops that openly sell booze to kids.”

And north-east MSP Maureen Watt said: “The scale of the increase inAberdeenis deeply alarming.

“It is the second largest increase acrossScotlandand more than three times the national average.”

The Nats MSP added: “Aberdeen Royal Infirmary is not the only hospital in which, on any night of the week, beds and trolleys are blocked by people sleeping off the effects of drink.

“Do taxpayers think that is a good use of their money and health professionals’ time? I do not think so.”

Dr Pauline Strachan, director of acute services at NHS Grampian, told a Holyrood committee: “If we look at accident and emergency attendance it was traditionally 20 to 30-year-olds.

“Now we see children as young as 10, 11 or 12 being presented in a drunken state.

“There had been a 60 per cent increase in children under 16 being admitted drunk at accident and emergency.

“Also about 20 or 25 years ago, it tended to be 50 or 60-year-olds who had chronic liver disease.

“Now it’s not unusual for people in their 20s.”

Ambulance chiefs inAberdeenrecently revealed they dealt with more than 6,000 calls during popular drinking times last year.

NHS Grampian said: “Alcohol misuse places an unnecessary burden on emergency services.”

Source:scottish-sun@the-sun.co.uk   15^th June 2010

Teenagers – especially girls – who binge drink could be damaging the part of their brain which controls memory and spatial awareness, say Californian researchers.

Young women’s brains are particularly vulnerable to harm from alcohol because they develop earlier than men’s.  Tests on 95 adolescents aged 16 to 19 were carried out by researchers at severalUSuniversities.

The study is published in Alcoholism: Clinical & Experimental Research.

Researchers recruited 27 binge-drinking males and 13 females and gave them neurophsychological tests and “spatial working memory” tests to complete.

Binge-drinking young women were defined as those drinking more than three pints of beer or more than four glasses of wine at one sitting. Binge-drinking men drank four pints of beer or a bottle of wine.   The same tests were then carried out on 31 males and 24 females who did not have episodes of drinking heavily and the results compared.

Using MRI scans, the study team found that female teenage heavy drinkers had less brain activation in several brain regions than female non-drinking teens when doing the same spatial task.  They suggested that this could cause problems when driving, playing sports involving complex moves, using a map or remembering how to get somewhere.

Susan Tapert, professor of psychiatry at theUniversityofCaliforniaand lead study author, said these differences in brain activity negatively affected other functions, like concentration and “working memory”.

The study describes “working memory” as using and working with information that is in your mind, like adding up numbers. It is also critical to logical thinking and reasoning.  But the young men studied were not affected to the same extent, Dr Tapert said.   “Male binge drinkers showed some, but less, abnormality as compared to male non-drinkers. This suggests that female teens may be particularly vulnerable to the negative effects of heavy alcohol use.”

Fluctuations

Previous research has shown that among adult alcoholics, women are more vulnerable to the damaging effects of alcohol on the brain than men.

Edith Sullivan, a professor in psychiatry and behavioural sciences atStanfordUniversity, said that the brains of adolescent boys and girls appear to be affected differently by alcohol.  “Females’ brains develop one to two years earlier than males, so alcohol use during a different developmental stage – despite the same age – could account for the gender differences.

“Hormonal levels and alcohol-induced fluctuations in hormones could also account for the gender differences. Finally, the same amount of alcohol could more negatively affect females since females tend to have slower rates of metabolism, higher body fat ratios, and lower body weight.”

Don Shenker, from Alcohol Concern, said the research demonstrates why reducing binge drinking among young people must be an urgent priority. “Ministers should go much further to clamp down on off-licence promotions which are driving under-age drinking and reviewing the extent of alcohol marketing which young people are exposed to and which makes drinking appear attractive.

“We have to also look at intervening as early as possible so that when teenagers go to A&E as a result of drinking or in trouble with the police or at school, they are provided with the right advice and support to reduce their risky drinking and make healthier choices.”

A Department of Health spokeswoman said “We are already taking action to tackle problem drinking, including plans to stop supermarkets selling below cost alcohol and working to introduce a tougher licensing regime.   ”Our recent white paper set out our plan to ring-fence public health spending and give power to local communities to improve the health of local people and this includes improving alcohol treatment services through a greater focus on outcomes and payment by results.   We will also be publishing a new alcohol strategy later this year to follow on from the public health white paper.”

Source: www.bbc.co.uk  16^th July 2011

Background

Alcohol is responsible for a significant portion of the global burden of disease. There is widespread concern reported in the media and other sources about drinking trends among young people, particularly heavy episodic or “binge” drinking. Prominent among policy responses, in theUKand elsewhere, have been attempts to manage antisocial behaviour related to intoxication in public spaces. Much less attention has been given to the longer term effects of excessive drinking in adolescence on later adult health and well-being. Some studies suggest that individuals “mature out” of late adolescent drinking behaviour, whilst others identify enduring effects on drinking and broader health and social outcomes in adulthood.

If adolescent drinking does not cause later difficulties in adulthood then intervention approaches aimed at addressing the acute consequences of alcohol, such as unintentional injuries and anti-social behaviour, may be the most appropriate solution. If causal relationships do exist, however, this approach will not address the cumulative harms produced by alcohol, unless such intervention successfully modifies the long-term relationship with alcohol, which seems unlikely. To address this issue a systematic review of cohort studies was conducted, as this approach provides the strongest observational study design to evaluate evidence for causal inference.

Methods

A systematic review was undertaken of the available literature using relevant online databases and standard systematic review literature search techniques. The search parameters included database articles from 1964 to 2008. This approach was supplemented through the use of hand searching of key journals, citation searching and contact with the primary authors of relevant studies. A data collection protocol was developed and the entire process was undertaken independently on two occasions by different researchers. All subsequent study tasks were also duplicated. Only peer-reviewed published data were used and further unpublished information was not sought from authors.

Studies of drinking behaviour were included if they collected data on at least two points in time, were at least 3 years apart, and from the same cohort. Cohorts formed from general population sources, including college students and military conscripts, were included. Studies based on selected or special populations such as children of alcoholics, mental health patients, and offenders were excluded.

We evaluated the strength of causal inference possible in these studies by assessing whether all possible contributing factors (confounders) had been taken into account. We also gave greater weight to studies that had follow-up rates of 80% or greater, and which had sample sizes of 1,000 participants or more.

Results

Fifty-four studies were eligible for inclusion in this review. Approximately half of all reports (n = 26) were from US studies, ten were fromSweden, eight fromBritain, four fromNew Zealand, three fromAustralia, two fromFinland, and one from theNetherlands. More than half (n = 30) originated from school-based cohorts. Birth cohorts were more likely to be the subject of multiple studies (n = 11/14). Nineteen (35%) studies, based on eight different cohorts, were assessed as having stronger capacity for causal inference), and we focussed primarily on these studies.

The main results were as follows –

• The majority of the studies provided evidence for a link between adolescent drinking and drinking behaviour in later adulthood.
• All studies assessing alcohol problems or dependence in adulthood found statistically significant associations with late adolescent drinking.
• Mortality was examined in only one cohort; the Swedish Conscript Study. It found that late adolescent heavy drinkers were twice as likely to have died compared to moderate drinkers by the mid-thirties. The majority of these deaths were due to car crashes and suicides. The risk of death due to alcohol specific causes (e.g. alcohol intoxication, liver cirrhosis) was also higher for this group.
• One study found no effect of adolescent drinking on court convictions or property offences by age 21, however one other study found that adolescent alcohol problems were predictive of official recorded criminal convictions by the mid-thirties.
• There was no effect of adolescent drinking on any of the mental health outcomes included in the studies, apart from the study noted above which did find that heavier adolescent drinkers had a higher risk of suicide in adulthood.
• One of the studies identified a small but significant effect of adolescent alcohol use on later tobacco use, however a similar relationship was not observed in other studies once confounding factors present in late adolescence were controlled.
• The majority of studies found that there was no association between adolescent drinking and drug use or dependence, after controlling for confounding.
• One study found a link between adolescent drinking at age 16 and educational attainment at age 42, however this effect was only evident in men.

Discussion

This systematic review investigated whether late adolescent alcohol consumption is a time-limited activity without significant longer term consequences or whether it impacts upon adult health and well being. It is clear that the evidence base on long-term consequences is not as extensive nor as compelling as it could be. There is a large evidence base attesting to the ongoing impacts of late adolescent drinking on adult drinking behaviours, though most studies cannot strongly support causal inferences because of their designs. There is robust evidence from one US National school cohort that apparent effects on later alcohol consumption persist beyond the age of 30, which is longer than had previously been understood. Possible effects on subsequent alcohol problems including dependence are somewhat more complex than effects upon subsequent alcohol consumption per se. Evidence from multiple well-designed cohort studies indicates that other factors indicative of heightened psychosocial risk more broadly are also implicated. It is nonetheless striking that effects on alcohol problems assessed at ages in the mid 30s appear to have been produced by elevated consumption in late adolescence. Findings from a rigorousNew Zealandbirth cohort study on nonalcohol outcomes, however, demonstrate that many apparent effects of late adolescent drinking are actually due to other factors. Certainty about the long-term consequences of late adolescent drinking is thus not easily achieved.

Notwithstanding the limitations of the evidence base and of this review, and attenuations over time in the strength of the direct effects, late adolescent alcohol consumption appears a probable cause of increased drinking well into adulthood, through to ages at which adult social roles have been achieved. Heavier drinking seems most likely, however, to be only one component in a complex causal process. The contribution of adolescent drinking has probably been overestimated in previous studies through not taking accouint of other possible explanations. There are also uncertainties induced by self-reported data. The importance of these findings is highlighted in the context of work showing strong stability of drinking patterns through the fourth and fifth decades of life. A wide range of health and other harms, such as liver cirrhosis, are caused by alcohol at middle and older ages. Late adolescent drinking, by virtue of its probable effect on long-term adult alcohol consumption is likely to contribute to the burden of alcohol-related disease. Continuities from adolescence to adulthood in drinking patterns have been observed across a range of measures including frequency of consumption and heavy drinking.

In this study it seems that alcohol consumption confers additional risk of alcohol problems both on those who are already more vulnerable in various ways to poorer health and psychosocial outcomes, and strikingly also among those who are not otherwise vulnerable. Possible effects on adult alcohol problems and dependence including hospitalisation identified here result from heavier drinking in adolescence without necessarily involving problems at younger ages. If these effects are confirmed, there are two important implications: (1) Reducing late adolescent alcohol consumption in the general population may be expected to make a long-term contribution to reducing the incidence of adult alcohol problems; (2) In more vulnerable populations, late adolescent drinking may be one cause among many of later difficulties, and its effects may be more severe and long-lasting than for other groups. Having relatively secure psychosocial resources may somewhat buffer these risks, and their consequent potential for adverse effects, but it does not remove them. These statements should be read with some caution given studies of mediators and moderators of these effects are lacking, limiting our understanding of their nature. Nevertheless, this systematic review affords more secure inference of the likely existence of these effects than has been possible previously. It is possible that relationships with alcohol forged during late adolescence may have cumulative lifetime drinking related consequences that are also simply not well captured by the existing literature.

In addition to making both alcohol and heavy drinking less available, less acceptable, and more expensive, these findings indicate a need for policy makers to encourage young people to be more cognisant of the long-term risks to adult health and well-being, and to act on this awareness in their decision making about whether and how much to drink. This encouragement requires much more than the provision of accurate information about risks if it is to have any real prospect of influencing actual behaviour. Alcohol harm reduction has largely been concerned with reducing various risks inherent in drinking situations and their immediate aftermaths. This study demonstrates the need to develop a longer term perspective on harm reduction.

Source:Alcohol Insights No.80

Abstract

A review of the existing literature on the occurrence of challenging behavior among children with prenatal drug exposure was conducted. While a large number of studies were identified that evaluated various outcomes of prenatal drug exposure, only 37 were found that directly evaluated challenging behaviors. Of the 37 studies, 23 focused on prenatal cocaine exposure, and 14 focused on prenatal alcohol exposure; most studies relied on broadband measures such as the CBCL for the assessment of challenging behavior. Among the 37 studies, a clear role for the postnatal environment on developing challenging behaviors was evident; however, prenatal alcohol exposure showed a much clearer independent effect upon challenging behaviors than was noted in the prenatal cocaine studies. Additionally, only 3 of the 37 studies addressed interventions for challenging behaviors, each of which showed an improvement in child behavior or parent-child interactions. As researchers have continued to show the importance of the postnatal environment, it is likely that interventions addressing specific environmental risk factors will be helpful to reduce or prevent challenging behaviors among this population.

Source:  http://www.ncbi.nlm.nih.gov/pubmed/18037268  Dec. 2008

 A growing body of research is showing that when it comes to treatments for alcohol use disorders, women’s needs are different from men’s. Scientists who recently presented studies at the Research Society on Alcoholism are exploring gender differences in alcohol treatment and moving beyond a one-size-fits-all strategy.

“Women have different barriers to treatment than men,” says Elizabeth Epstein, PhD, Research Professor in the Clinical Division of theCenterofAlcohol StudiesatRutgersUniversityinNew Brunswick,NJ. “They are less likely to seek alcohol treatment in a dedicated alcohol facility, and more likely to seek treatment with a general practitioner or psychiatrist for depression or fatigue.” However, many of these doctors don’t routinely screen for an alcohol or drug use problem, she explains.

“We know that 85 percent of people who have alcohol problems in their lifetime don’t seek treatment for it, so we are focusing most of our treatment research resources on the 15 percent who do,” according to Dr. Epstein. “We need to look beyond that, to who is struggling without treatment.” More training in alcohol use disorders is needed for emergency department physicians, obstetrician/gynecologists and family practitioners, she states. “We need to develop interventions that allow doctors to screen for alcohol use problems, since we know that women are not likely to come in and say they drink too much.”

Alcohol tends to affect women more than men for several reasons. Dr. Epstein explains, “A woman who weighs the same as a man and consumes the same amount of alcohol over the same length of time is likely to have a higher blood alcohol level. Women have less body water than men, leading to a higher blood alcohol concentration, and they also have less lean muscle mass and fewer enzymes in the stomach that break down alcohol. That means more ethanol is going into the bloodstream and directly to organs like the heart, brain and liver, and doing damage.”

She notes that women develop a host of alcohol-related health problems more quickly than men, even though they tend to start drinking later. “Older womens’ bodies are not processing anything as well as younger women, including alcohol,” she says. “And we are seeing younger women’s drinking patterns catching up with men’s, which is not a good thing. That means that as this generation progresses, we’ll see more and more older women with alcohol problems.”

Success With Individual Therapy

Dr. Epstein is leading the Rutgers Women’s Treatment Project at theCenter ofAlcohol Studies. This five-year clinical research study, funded by the National Institute of Alcohol Abuse and Alcoholism, is testing the effectiveness of therapies for women with drinking problems.

She and her colleague, Dr. Barbara McCrady, looked at marital therapy combined with alcohol therapy for women, testing it against individual alcohol therapy for women. “The women in both groups did very well, reducing their drinking days from an average of about 70 percent before the study, to 20-30 percent while in and after treatment,” states Dr. Epstein. The coupled treatment conferred a slight advantage in terms of maintaining the gains in the year following treatment. That study required women to be in a committed relationship or marriage to a male to be eligible. Many women didn’t want to sign up, because their spouse had to be involved.

Both doctors then offered a choice of either individual therapy or couples therapy in a two-armed clinical research study to treat alcohol use disorders. For that study, women had to be in a committed relationship, but did not need to bring their partner in if they chose individual therapy. Most women in that study chose individual therapy. Women who chose individual therapy were randomly assigned to regular cognitive behavioral therapy (CBT) or female-specific CBT. In CBT, emphasis is placed on the importance of breaking the drinking habit and learning coping skills.

The female-specific treatment also emphasized womens’ rights to care for themselves, and helped them feel more self-confident and less sensitive to what other people thought about them. The treatment provided assertiveness training and helped women address how to deal with a partner who drinks heavily, and with anxiety and depression. Women learned about anger management and how to make connections with sober people who treat them well and don’t abuse them.

While women in both groups showed improvement in their drinking, Dr. Epstein and her colleagues found that women who chose individual therapy were more likely to stick with therapy than those who chose couples therapy.

Currently Dr. Epstein is investigating the effectiveness of female-specific-CBT treatment delivered in women-only groups. She explains, “We want to be able to develop treatments for a broad range of women, which could be integrated into community-based therapy.”

Trauma and Substance Abuse Linked

Many women with substance abuse disorders also suffer from post-traumatic stress syndrome (PTSD), resulting from interpersonal violence, says Denise Hien, PhD, ABPP, who presented data at the meeting about promising treatments for women who suffer from PTSD and substance use disorders. “They drink in response to trauma,” says Dr. Hien, Professor at the City University of New York, and Adjunct Senior Research Scientist at Columbia University College of Physicians and Surgeons inNew York.

Dr. Hien compared a type of CBT called “Seeking Safety” for substance abuse and PTSD with a relapse prevention treatment. “Seeking Safety” is a short-term treatment for both trauma and substance abuse in women. Both disorders are treated at the same time by the same clinician. Secondary analyses indicate that trauma therapy may be most effective for women who are also receiving some type of self-help, such as being part of a 12-step group. “If a person is not affiliated with a self-help group, she may actually get worse from trauma therapy alone,” Dr. Hien says.

Last year, she published a study in the American Journal of Psychiatry that found if you treat the PTSD symptoms first, in women who suffer from both substance abuse and PTSD, it led to a reduction in substance abuse. The study found little evidence that treating substance abuse first improved PTSD symptoms. Currently, patients who suffer from both disorders often are not treated for PTSD until they receive addiction treatment and stop using drugs and alcohol. This sequence is based on the assumption that addressing trauma could worsen a person’s substance abuse.

Dr. Hien is also conducting a clinical trial that is examining whether adding the antidepressant sertraline HCI (Zoloft) to trauma therapy benefits women with PTSD and alcohol misuse or alcohol use disorders.

Source: The Partnership@DrugFree.org  July 2011

Lying in a hospital bed, 24-year-old Stacey Rhymes cuddles a childhood toy before putting out an arm to her mother.

‘Hold my hand, Mum,’ she whispers, then slips into a coma. A few hours later, on a spring afternoon earlier this year, the girl with a whole life ahead of her was dead.

The once radiantly pretty Stacey had drunk herself to death on cut-price bottles of wine bought from corner shops, supermarkets and local pubs. She had started drinking at 17 and seven years later her body simply gave up under the constant assault from alcohol.

 Her mother, Louise, says: ‘I now want the world to know exactly what happened to Stacey and why. It was a terrible way to go.   ‘Her stomach was like a balloon, as if she was nine months pregnant. Her long hair was falling out, her urine was coloured black and she could not eat. She was scared to look in the mirror because her eyes were canary yellow. The only way to stop the pain at the end was morphine.’

The story of Stacey Rhymes is a salutary one. She is one of the youngest people in modern Britain to die of alcohol abuse. And her mother, speaking for the first time, is determined that the loss of her daughter will not be in vain.
 
She has set up a Facebook website in memory of Stacey to highlight the dangers of alcohol – and particularly its increased availability following New Labour’s 24-hour drinking laws – which now kills more young women than cervical cancer, and more people, generally, than hard drugs.

A film clip about Stacey on YouTube, put there by her mother, has been watched by 16,000 people in a fortnight. It is now one of the most viewed in Britain by children and teenagers.

At the family’s terrace home, in Bramcote, on the outskirts of Nottingham, where Stacey grew up with her brother, Jay, now 19, sister Katie, 21, and stepfather, Terry, her mother says: ‘Alcohol is as treacherous as a Class A drug. Yet it’s available at all hours and at rock-bottom prices.

‘This morning, I saw a pack of four cans of lager at the supermarket for 92p. You can’t get four cans of children’s pop for that! Young children should be warned about alcohol in the way they are warned about drugs.  ‘I want them to be shown a photograph of Stacey’s face when she was dying. She was killed by alcohol – a drug that is as easy and cheap to buy as a packet of sweets.’

Since the relaxation of licensing laws in November 2005 – which allowed round-the-clock sales of drink in pubs, clubs, shops and supermarkets – the cost to the nation both socially and financially has been huge. Coupled with low prices for alcohol, there is now an orgy of drunkenness that rivals the gin epidemic of early Victorian times.

The facts are stark. The numbers dying from alcohol-related health problems is rising. In 1999, there were 4,000 deaths. Today, the figure has doubled, with the age of the victims going down, too. Hospitals admit for emergency treatment more than 9,000 drunken teenagers every year.

According to Alcohol Concern, 800,000 children below the age of 15 drink regularly in Britain. Nearly two-thirds of them will have had alcohol in the past month – with one in seven consuming enough to make them sick. One in three think, it is acceptable to get drunk once a week.

Campaigners say that one in ten eight-year-old boys (double the figure ten years ago) and a quarter of 11-year-old girls (ten per cent more than in 1995) have also experimented with alcohol.    Staff at the casualty department of Alder Hey Children’s Hospital in Liverpool will not be surprised by these statistics. A survey by the hospital – which admits only under-17s – showed that more than half the children treated after binge-drinking had bought their alcohol from a pub or a shop.

Nearly three-quarters of patients are girls, and the favourite tipple is vodka. Every week, seven or eight drunken youngsters are treated at the hospital – a quarter so ill that they have to be put on a ward or go into intensive care.

According to Pat McLaren, an Alder Hey spokeswoman: ‘They come in on a Friday and Saturday night in particular. Some are found unconscious on the street or even beaten up. We get them sober and contact their parents. We try to get them to change their ways.’

Alder Hey and Liverpool are not alone. Cases of liver cirrhosis in 20 to 30-year-olds – who often started drinking as children – have doubled in less than a decade.  Eight women in Britain die each day from liver disease – often at ages younger than men with the same condition because their bodies are more sensitive to alcohol poisoning.

As Professor Ian Gilmore, President of the Royal College of Physicians, warns: ‘The damage to society from alcohol is greater than from drugs.’   Dr Gray Smith-Laing, a gastroenterologist at Medway Maritime Hospital in Gillingham, Kent, says: ‘The young of all social backgrounds think it is cool to get completely legless, yet nothing could be more uncool. This is a classless and sexless phenomenon. We have not seen the peak yet.’

Young women such as Stacey Rhymes make up half his caseload. Some have irreversible liver damage from drinking. One woman of 26 he treated recently died of liver cirrhosis.  Dr Smith-Laing says: ‘We need a dramatic rise in the price of alcohol so it is no longer affordable for the young.’
 
It is against this frightening background that Stacey’s mother has bravely decided to speak out.

She reaches for a pile of treasured childhood photographs. They show Stacey on her first birthday; at eight in a white hat at a family wedding. There is one of her with bright, clear eyes and long thick hair smiling at the camera  - she is just 17, and it is a few months before she began to drink.

Louise, 43, says: ‘Stacey had a wonderful childhood and we were a close family. There wasn’t a lot of money, but we did old-fashioned things. We went to the park for picnics and walks around Nottingham.  ‘She had lots of friends and when she left school at 16, she got a job in a local pub as a waitress. She met a boy, and there was even talk of an engagement.’

But things were soon to change. ‘For no apparent reason, Stacey began to drink. She had arguments with the boyfriend about it. She lost the job she loved and her boyfriend, too. She was just drinking all the time. She became foul-mouthed. She stole money from us, her family, to buy the alcohol,’ says Louise. ‘Stacey would go out drinking at night then lie in bed all day. I couldn’t get her up, even though I tried before I left for work.

‘In the end, we found her a housing association flat in Nottingham, where she moved. We thought it would be a fresh start.’ Nothing could be further from the truth.

‘Stacey then got in with a bad crowd. Her friends were all drinkers, too. She would lie in bed with a bottle. A few times, she burned the bedclothes with her cigarettes. She got involved in a serious brawl, and was sent to prison for eight weeks.

‘We were horrified, but she came out looking far better. She had not been able to drink while inside. We took her back to her flat where there were eight weeks – £800-worth – of giro cheques from the benefits’ office. Stacey spent every penny on drink. She was evicted from her flat due to debts on the rent.’   Stacey wouldn’t move back home because her mother and stepfather, a self-employed builder, refused to allow her to drink. Revolted by what alcohol had done to their daughter, they are now teetotal.   Instead, Stacey found a place at a hostel in Derby, five miles from Nottingham. ‘That lasted five days before she was thrown out for drinking,’ recalls her mother.

By now, her life was out of control. For a time, Stacey lost contact with her family. She lived rough in Derby. In desperation, Louise tried to get her daughter sectioned under the mental health laws so she would be taken into hospital. ‘But the authorities said she was quite normal, just an alcoholic.’ she recalls today.   Stacey was now drinking five litres of wine a day and some cider, too. She no longer dressed fashionably, put on weight and didn’t eat properly. ‘Her stomach was huge and she was very ill,’ her mother says.

On March 28 this year, Stacey was admitted to Derby Hospital – to Ward 308 which deals with alcohol-induced liver problems. She had been to her GP because her face had gone yellow and she was having trouble walking because her limbs were swollen. The doctor told her to go to hospital immediately  -  it took her a week to do so.

Dr Jan Freeman, a consultant in whose care she was put, says: ‘Stacey was at the end of the road. She could have been saved only by a liver transplant. Like lots of young people, she never thought it would happen to her. Well, Stacey’s death shows it can happen to some.’    There is no doubt that Stacey was well looked after in the hospital but, during the next seven weeks, until her death on May 22, she managed to discharge herself three times and return to drinking.

Once, she walked out in her pyjamas, hailed a taxi then disappeared. Derby police put out appeals for the public to look for her. Her parents searched, too.    He mother recalls: ‘We got her back to the hospital on each occasion. The last time was on May 17. She had been staying with a drinking buddy. She rang up saying she was being sick and it was streaked with blood. Her skin was itching, a symptom of alcohol poisoning.

‘I knew that we would lose her, because of her colour. I thought she wouldn’t make it over the weekend. But three days later, she had picked up and told us she was scared of dying. I told her that if she stopped drinking, she would live.’    It was, of course, a white lie. The next day, the hospital rang Louise to say Stacey had a hole in her stomach, caused by acid from a ruptured peptic ulcer. There was nothing more the doctors could do.   Within 24 hours, the family were called to the hospital for the final time. Stacey died in her mother’s arms of abdominal bleeding and alcohol-related liver disease.

As confirmation of Stacey’s tragic story, Nick Sheron, a liver specialist at Southampton General Hospital and secretary of campaign group, Alcohol Health Alliance, says drink-induced liver disease – once the preserve of middle-aged men – is affecting all ages and both sexes.

He explains: ‘If they are alive, it is never too late to stop drinking. But, often the symptoms show up so late that half the patients die before they have a chance to change their ways.

‘In the Sixties and Seventies, wine used to be nine percent proof, now it is 13 percent. Beer was 3.2 percent, now a lager is five percent. The size of a wine glass is bigger, too  -  from 125ml to 175ml, and in some cases 250ml. That is a third of a bottle.’

Dr Sheron warns that alcohol is being used as a drug, instead of a part of a social event or accompaniment to a meal. ‘The young drink to get wasted as quickly as possible. They think if they can remember the night before it is not a good night out, and 24-hour licensing is one of the problems,’ he cautions.

With prices so low, Professor Mark Bellis, director of the Department of Public Health at John Moores University in Liverpool, adds: ‘A young person with £10-a-week to spend can get drunk three times a week.’   The scale of the crisis cannot be over-stated. Alcohol abuse, leading to either injury or disease, now costs the NHS £1billion annually with 40 per cent of casualty departments’ admissions being drink-related.

Significantly, the London Ambulance Service says that alcohol-related emergency calls have increased by 12 per cent since 24-hour drinking laws were introduced.   As spokeswoman Anna Lowman says: ‘One of the aims of the new laws was to eradicate the 11pm to 2am disorder flashpoint when the pubs and off-licences used to close. But this is still our busiest period. Fourteen per cent of all calls during these hours are linked to drinking.’

Yet this is not the only catastrophic side-effect. The Cabinet Office admits the real cost of drinking is £20billion a year if you include suicides, alcohol-fuelled crime, anti-social behaviour, depressive illness, family breakdown and domestic violence.

Only this month, the Local Government Association – representing councils – warned the 24-hour drinking plan to emulate a European style cafe-culture in Britain had failed miserably. It costs £100 million a year to oversee the late licensing system, provide staff to clean town centres of vomit or urine (often both) and help for the ‘walking wounded’ at the end of a night’s hard drinking.

At Stacey Rhymes’ funeral in Bramcote, held near the park where the family used to picnic, there were 150 mourners – some were her old school friends. As her mother says: ‘Stacey chose her way – and they theirs. They have got married, have children and careers. They are enjoying life. My daughter drank herself to death.   ‘She never had any problems getting her hands on another bottle. In many ways, she was a victim of our times.’

 Source  Newspaper cutting  – sent to NDPA not identified.

Research Summary

Researchers say that a drug that blocks a brain protein called NK1R (neurokinin-1 receptor) involved in stress response appears to reduce alcohol craving, ABC News reported Feb. 14.
Building on studies showing that mice lacking NK1R seemed to lose interest in alcohol, researchers from the National Institute on Alcohol Abuse and Alcoholism gave NK1R-blocking drugs to a group of 25 alcoholics and compared their craving responses to those of 25 other alcoholics given a placebo. Those receiving the blocking drug reported about half the level of craving for alcohol as the control group.
Markus Heilig, NIAAA’s clinical director, said the study points to a new approach to addiction treatment by focusing on reducing craving rather than preventing the pleasurable effects of alcohol consumption. “We’re really trying to open up a new category of treatments that would help most people,” he said.
“This is a potentially important finding which indicates a novel mechanism for reducing craving in individuals who drink to reduce high anxiety,” said pharmacology expert Boris Tabakoff of the University of Colorado at Denver.
“It may be that this medication would help alcoholics who drink when stressed,” added Charles O’Brien of the Treatment Research Center for the University of Pennsylvania Health System, although he stressed: “It is wrong to think of all alcoholics as alike.”
The study was published online in the journal Science.

Source: Join Together Feb. 2008

Research Summary
People in recovery from alcohol addictions can suffer sleep disruptions for months or years after they stop drinking,
Researchers at SRI International monitored the brain activity during sleep of a group of 42 people in recovery and compared the results to brain scans of nondrinkers. They found that men and women in recovery spent significantly less time in light, stage-one sleep and slow-wave sleep — the latter essential for memory — and somewhat more time in REM sleep, when dreaming normally occurs.
Researcher Ian Colrain and colleagues said the sleep disruptions probably worsen the mental problems associated with long-term drinking.

Source: Sleep. Oct. 1, 2009

Academics at Northumbria University have demonstrated a link between teenage binge drinking and damage to prospective memory.

Prospective memory is an important aspect of day-to-day memory function and is defined as the cognitive ability to remember to carry out an activity at some future point in time. Examples include remembering to attend an appointment at the dentist or to carry out a task such as remembering to pay a bill on time.

In the first study to examine the effects of binge drinking on prospective memory in teenagers, researchers tested the ability of fifty students from universities in North East England to remember a series of tasks. The students were shown a 10-minute video clip of a shopping district in Scarborough and were asked to remember to carry out a series of instructions when they saw specified locations.
Twenty-one of the students were categorized as binge drinkers. For women, this meant that they drank the equivalent of six standard glasses of wine or, for men, six pints of beer, two or more times a week. The remaining 29 participants were categorised as non-binge drinkers.

The study found that the binge drinkers recalled significantly fewer location-action/items combinations than their non-binging peers. These findings were observed after screening out teenagers who used other substances (such as ecstasy, cannabis and tobacco), those who had used alcohol within the last 48 hours, and after observing no between-group differences on age, anxiety and depression.

Dr Tom Heffernan led the study. He comments: “The mechanisms that may underlie such everyday cognitive impairments associated with binge drinking are not yet fully understood. It is possible that excessive drinking may interfere with the neuro-cognitive development of the teenage brain.

“It is important to realise that there no ‘safe’ levels of drinking set for teenagers and that the amount of bingeing revealed in the present study represents a high volume of alcohol intake across the two to three bingeing sessions which were the norm in the group. The high levels of drinking amongst teenagers is particularly worrying given the mounting evidence that the teenage brain is still maturing and undergoing significant development in terms of its structure and function.
“Given that teenagers are inexperienced drinkers who have both a low tolerance for alcohol and immature neuro-physiological systems, they should therefore be drinking much less than the ‘safe’ levels recommended for adults.”

Intriguingly, one other finding of the study is that binge drinkers do not perceive themselves to have a poor memory, suggesting teenagers do not appreciate the damage that is being done.

Source: T. Heffernan, R. Clark, J. Bartholomew, J. Ling, S. Stephens. Does binge drinking in teenagers affect their everyday prospective memory? Drug and Alcohol Dependence, 2010; 109 (1-3): 73 DOI: 10.1016/j.drugalcdep.2009.12.013 Northumbria University (2010, July 29).

A new study suggests that genetic factors influence size variations in a certain region of the brain, which could in turn be partly responsible for increased susceptibility to alcohol dependence.

It appears that the size of the right orbitofrontal cortex (OFC), an area of the brain that is involved in regulating emotional processing and impulsive behavior, is smaller in teenagers and young adults who have several relatives that are alcohol dependent, according to a study led by Dr. Shirley Hill, Ph.D., professor of psychiatry, University of Pittsburgh School of Medicine.
In the research, which was published this week in the early online version of Biological Psychiatry, Dr. Hill and her team imaged the brains of 107 teens and young adults using magnetic resonance imaging. They also examined variation in certain genes of the participants and administered a well-validated questionnaire to measure the youngsters’ tendency to be impulsive.
The participants included 63 individuals who were selected for the study because they had multiple alcohol-dependent family members, suggesting a genetic predisposition, and 44 who had no close relatives dependent on drugs or alcohol. Those with several alcohol-dependent relatives were more likely to have reduced volume of the OFC.
When the investigators looked at two genes, 5-HTT and BDNF, they found certain variants that led to a reduction in white matter volume in the OFC, and that in turn was associated with greater impulsivity.
“We are beginning to understand how genetic factors can lead to structural brain changes that may make people more vulnerable to alcoholism,” Dr. Hill said. “These results also support our earlier findings of reduced volume of other brain regions in high-risk kids.”
These differences can be observed even before the high-risk offspring start drinking excessively, she added, “leading us to conclude that they are predisposing factors in the cause of this disease, rather than a consequence of it.”

Source: University of Pittsburgh Schools of the Health Sciences (2008, November 7). Impulse Control Area In Brain Affected In Teens with Genetic Vulnerability for Alcoholism

Even mild alcohol intoxication can seriously impair drinkers’ visual acuity, according to a study from the University of Washington.
Researchers found that test subjects who consumed just enough alcohol to reach half the legal alcohol intoxication level in the U.S. performed poorly on tests of their ability to notice an unexpected visual object when they were performing another simple task. Researchers said this was the first study to demonstrate that alcohol can cause such “inattentional blindness.”
“We rely on our ability to perceive a multitude of information when we drive (speed limit, road signs, other cars, etc.),” said study lead author Seema Clifasefi. “If even a mild dose of alcohol compromises our ability to take in some of this information, in other words, limits our attention span, then it seems likely that our driving ability may also be compromised.”
The study was published in the July 2006 issue of the journal Applied Cognitive Psychology.
Reference:
Clifasefi, S. L., Takarangi, M. K. T., Bergman, J. S. (2006) Blind drunk: the effects of alcohol on inattentional blindness. Applied Cognitive Psychology, 20(5): 697-704.

Source:Reported in Medical News Today July 7, 2006

Children from families with a history of alcohol abuse show characteristics in their brains that may make them more susceptible to becoming problem drinkers themselves, a new study reports.
Using magnetic resonance imaging, researchers from the University of Pittsburgh found potentially significant structural differences in the brains of teenagers from families with multigenerational drinking problems. The report was published in a recent issue of Biological Psychiatry.
The lead author, Dr. Shirley Y. Hill, said the study had found that the right portion of a brain area called the amygdala appeared smaller than normal in the teenagers studied. The amygdala helps control emotions, the researchers said, and appears to play an important role in addictive behavior like gambling and drug use.
The researchers looked at 34 boys and young men whose family histories were believed to put them at high risk; their average age was 17. The study found that some of the deviations in the brain occurred even if the subjects were not using alcohol. They said that fact suggested a genetic component.
The researchers said they suspected that the teenagers’ brains would eventually develop normally if they avoided alcohol. But studies have shown that children from families with long histories of drinking start using alcohol earlier.
Source: New York Times July 12 2006

The Inextricable Link

Research substantiates the link between violence and alcohol/drug use among adolescents. This link exists not only
for the perpetrators of violence, but also for those who are victims of violence. Eliminating the State Grants portion of the Safe and Drug Free Schools and Communities (SDFSC) program will undoubtedly lead to increases in violence,alcohol and drug use among school-aged youth.

Student Alcohol Use and Violence

• Alcohol use is an independent risk factor for delinquent and violent behaviors among young people.
• Adolescents who abuse alcohol are three times more likely to commit violent offenses than those who do not drink to excess.
• Youth aged 12-17 who reported violent behaviors in the past year also reported higher rates of past year alcohol use compared with youths who did not report violent behavior.

65.9% of those youth reporting heavy alcohol use, 56.8% of those reporting binge drinking, and 43.7% of those reporting past 30-day use of alcohol had also engaged in one or more of the following delinquent behaviors: participating in a serious fight at school or at work; participating in a group-against-group fight; attacking someone with the intent to seriously hurt them; stealing or attempting to steal something worth $50 or more; selling illegal drugs; and/or carrying a hand gun within the last year.

• Alcohol use among adolescents co–occurs with a range of other risky behaviors including violence, tobacco use, sexual activity, drinking and driving and suicide.

Student Alcohol Use and Victimization

• Those who drink, including adolescents, may experience an increased risk of violence because of reduced physical coordination, poor decision-making in threatening situations and isolation while out late at night.
• Alcohol increases vulnerability to victimization above levels of vulnerability brought about other factors.

Student Drug Use and Violence

• Youths who had engaged in fighting or other delinquent behaviors were more likely than other youths to have
used illicit drugs.
• Of those students who reported carrying a gun to school during the 2005-2006 school year, 63.9% report also
using marijuana, 39.9% report using cocaine, and 36.8% report using crystal meth in the past year.
• Of those students who reported hurting others with a weapon at school, 68.4% had used marijuana, 48.3%
had used cocaine, and 44.1% had used crystal meth in the past year.
• Of those students who reported being hurt by a weapon at school, 60.3% reported using marijuana, 41.1% reported
using cocaine and 38.3% reported using crystal meth in the past year.
• Past month illicit drug use was reported by 17.3% of youths who had gotten into serious fights at school or
work in the past year compared with 7.6% of those who had not.
• The incidences of youth physically attacking others, stealing, and destroying property increased in proportion
to the number of days marijuana was smoked in the past year.
• Marijuana users were twice as likely as non-users to report they disobeyed school rules.
• Of those students who reported threatening someone with a gun, knife or club or threatening to hit, slap or kick
someone during the 2005-2006 school year, 27% also reported using marijuana, 7.8% reported using cocaine and 6.2% reported using crystal meth in the past year.
• During the 2005-2006 school year, of those students who reported any trouble with the police, 39.6% also reported
using marijuana, 12.2% reported using cocaine, and 9% reported using crystal meth in the past year.

Community Anti-Drug Coalitions of America > 625 Slaters Lane, Suite 300 > Alexandria, VA 22314 > T 800.542.2322 > cadca.org
CSSourmunity Anti-Drug Coalitions of America > 625 Slaters Lane, Suite 300 > Alexandria, VA 22314 > T 800.542.2322 > cadca.org

Footnotes

1 Komro, K.A., Williams, C.L., Foster, J.L., et al. (1999).
The relationship between adolescent alcohol use and delinquent
and violent behaviors. Journal of Child Adolescent
Substance Abuse, 9(2):13-28.
2 Fergusson, D.M., Lynskey, M.T., Horwood, L.J. (1996).
Alcohol misuse and juvenile offending in adolescence. Addiction,
91(4): 495-510.
3 Office of Applied Studies, Substance Abuse and Mental
Health Services Administration. (2005). The NSDUH report:
Alcohol use and delinquent behaviors among youths. Available:

http://www.oas.samhsa.gov/2k5/alcDelinquent/

alcDelinquent.pdf
4 Ibid.
5 Windle, M. Alcohol Use Among Adolescents. Thousand
Oaks, CA: Sage, 1999.
6 Shepherd, J.P.(1998). Emergency room research on links
between alcohol and violent injury. Addiction, 93(8): 1261–
1262.
7 Shepherd, J.P.; Sutherland, I.; Newcombe, R.G. (2006)
Relations between alcohol, violence and victimization in
adolescence. Journal of Adolescence, 29(4): 539-553.
8 Office of Applied Studies, Substance Abuse and Mental
Health Services Administration. National Survey on Drug
Use and Health: National Findings. (2005). Youth Prevention-
Related Measures: Fighting and Delinquent Behavior.
64. Available: http://oas.samhsa.gov/
nsduh/2k5nsduh/2k5results.pdf.
9 Pride Surveys. (2006). Questionnaire report for grades 6-
12: 2006 national summary. 184. Available: http://
www.pridesurveys.com/customercenter/us05ns.pdf.
10 Pride Surveys. (2006). Questionnaire report for grades 6-
12: 2006 national summary. 197. Available: http://
www.pridesurveys.com/customercenter/us05ns.pdf.
11 Pride Surveys. (2006). Questionnaire report for grades 6-
12: 2006 national summary. 199. Available: http://
www.pridesurveys.com/customercenter/us05ns.pdf.
12 Office of Applied Studies, Substance Abuse and Mental
Health Services Administration. National Survey on Drug
Use and Health: National Findings. (2005). Youth Prevention-
Related Measures: Fighting and Delinquent Behavior.
64. Available: http://oas.samhsa.gov/
nsduh/2k5nsduh/2k5results.pdf.
13 Office of National Drug Control Policy. (2006). Marijuana
Myths and Facts: The Truth Behind 10 Popular Misperceptions.
10. Available: http://www.whitehousedrugpolicy.gov/
publications/marijuana_myths_facts/
marijuana_myths_facts.pdf
14 Ibid.
15 Pride Surveys. (2006). Questionnaire report for grades 6-
12: 2006 national summary. 194. Available: http://
www.pridesurveys.com/customercenter/us05ns.pdf.
16 Pride Surveys. (2006). Questionnaire report for grades 6-
12: 2006 national summary. 195. Available: http://www.pridesurveys.com/customercenter/us05ns.pdf.ourceThe Inextricable S
Source: Cadca online Nov. 2006

WARNING labels telling pregnant mothers they risk doing irreversible harm to their unborn children by drinking could be put on alcoholic products after the number of damaged babies has soared.
Cases of infants born with foetal alcohol syndrome (FAS) – which can cause mental retardation and birth defects if a mother drinks throughout pregnancy – have doubled in NSW from 15 in 2001 to 32 in 2004.
But experts believe the real figure is likely to be up to 10 times higher.
Research suggests even one bout of binge drinking during pregnancy could cause foetal alcohol spectrum disorders, leaving a child with behavioral and learning disabilities.
NSW Health Minister John Hatzistergos said yesterday the Government is researching new alcohol pregnancy guidelines and is considering rolling out health advisory labels.
Mr Hatzistergos said: “We need to know two things. What impact drinking during pregnancy has and what is the nature of any warning that should be provided on alcohol products.”
There is currently no national standard advice for drinking during pregnancy, but research suggests even moderate drinking late in pregnancy can cause FAS.
University of Sydney’s Professor of Paediatrics Health Dr Elizabeth Elliot said: “For every child with FAS there are 10 more with neuro-developmental problems caused by alcohol.
“We are certainly seeing new cases diagnosed every year and that is just the severe end of the spectrum.
“We also know many women are unaware a single binge early in pregnancy could damage their foetus.”
At the ministerial council on drug strategy last week, state and federal ministers discussed new, nationwide approaches to reduce the rate of FAS.
Mr Hatzistergos said a working party will examine research and discuss what alcohol warning labels would say.
He did not dismiss the possibility labels would use photographs similar to new cigarette warning labels.
He said: “Down the track that may be something. I think the best approach is to abstain, but I don’t want to create anxiety among women – there needs to be a greater level of awareness about this issue.”
New research shows 78 per cent of FAS children studied between 2000 and 2004 were exposed to drugs in addition to alcohol and the average age of diagnosis was 3.3 years old.
Alarmingly, of the 133 FAS children examined, 27 per cent had a sibling also affected by alcohol.
A new documentary, In The Womb, using unique 4D technology is now available and tracks the development of the foetus in-utero from fertilisation to birth as well as showing the impact of smoking and excess alcohol on unborn children.
One of the most expensive films of its kind, the DVD was made

Source: Daily Telegraph. Australia Dec. 18th 2006

Emma Dickinson

One in three drivers suspected of driving while ‘over the limit’ but subsequently found to be below maximum permissible levels of alcohol, nevertheless tested positive for a range of drugs, reveals research in Injury Prevention.

The findings prompt the authors to call for routine drugs testing in all drivers who are suspected of being over the limit for alcohol.

The researchers base their findings on 2000 blood and urine specimens taken from drivers who had been stopped by police on suspicion of driving while ‘under the influence’ over a period of two years in Ireland.

Half of the specimens were below the maximum legal alcohol limit of 80 mg/100 ml for blood and 107 mg/100 ml for urine. The other half were all above.

But when analysed further, one in three samples below the legal limit, tested positive for a range of drugs. These drivers were also more likely to be taking a cocktail of drugs.

This rate was almost twice as high as that of drivers over the legal limit, one in seven of whom tested positive for drugs.

The drugs found included amphetamines, metamphetamines, benzodiazepines, cannabis, cocaine, opiates and the heroin substitute methadone. The most commonly found drug was cannabis.

Rates of testing positive for drugs were marginally higher among men than they were among women.

Based on the samples in the study, the authors calculate that almost 16% (one in six) of all drivers stopped and tested under suspicion of driving under the influence of an ‘intoxicant’ would test positive for drugs.

As blood alcohol levels rose, the likelihood of testing positive for drugs fell. But more than one in 10 drivers at least 2.5 times over the legal limit for blood alcohol (greater than 200 mg/100ml) also tested positive for drugs.

And among those with minimal blood alcohol levels, over two thirds tested positive for at least one type of drug, the findings showed.

Being under the legal limit for alcohol, being stopped in a city, stopped between 6 am and 4 pm or between 4 pm and 9 pm, and being under 35 years were all independently associated with drug taking.

Too little attention has been paid to the adverse effects of drugs on driving, but drugged driving can be as dangerous as drunken driving, say the authors.

###

Source:http://www.medicalnewstoday.com British Medical Journal, Specialty Journals 26 Dec 2006

Long-term alcoholics are running the risk of permanent brain damage, according a study published today.
Research has shown that while the brain can regenerate following damage caused by drink, it struggles more after longer periods.
Scanning technology and computer software was used to analyse how the form, function and size of brains in 15 patients changed over a period of six to seven weeks after they gave up alcohol. The researchers, from the UK, Switzerland and Italy, found that brain size increased by an average of almost 2 per cent 38 days after the start of the study.
Levels of chemicals that indicate how intact the brain’s nerve cells and sheaths are also rose significantly, by around 10 per cent to 20 per cent.
Only one patient appeared to continue to lose brain volume and he was the one who had been drinking the longest, for 25 years, the study found.
Dr Andreas Bartsch, from the University of Wuerzburg in Germany, who led the research, said: “The core message from this study is that, for alcoholics, abstention pays off and enables the brain to regain some substance and to perform better.
“However, our research also provides evidence that the longer you drink excessively, the more you risk losing the capacity for regeneration.” The results of such brain scans could be used to help keep alcoholics motivated on staying sober, Dr Bartsch added.
Furthermore, the findings, published in the online edition of the journal Brain, did not simply reflect rehydration.
“Instead, the adult human brain, and particularly its white matter [where nerve fibres are], seems to possess genuine capabilities for regrowth,” Dr Bartsch said.

Scotsman Source: www.aa-uk.org.uk Dec/ 18 2006

How serious is the child and teenage alcohol problem in your area?
More than 20 children and teenagers are being treated in hospital every day for alcohol-related illnesses, including mental disorders, poisoning and liver disease, according to newly released official data.
The figures, labelled “staggering” by one of Britain’s most senior doctors, show that in the year 2005-6, during which Labour introduced 24-hour drinking, the number of under-18s seeking treatment for alcohol-related health problems leapt by 13% to 8,894, an average of 24 a day.
The research, released in parliament by Caroline Flint, the health minister, shows that the number treated has gone up by 33% since Labour came to power in 1997.
Professor Ian Gilmore, president of the Royal College of Physicians, said: “This is a staggering rise and it is only the tip of the iceberg.
“Drinks sold by supermarkets and off-licences are cheaper than ever, and those shops have been at the front of the queue for 24-hour licences, so it has never been more available.
“The younger they drink, the more likely they are to have alcohol-related problems later in life. It is now commonplace to see men and women in their twenties with end-stage alcoholic liver damage.”
The disease figures released by Flint do not include those people treated for injuries sustained in incidents such as drunken fights or drink-driving.
Separately, the government has released figures for patients treated for alcohol-related conditions in accident and emergency wards, showing that alcohol-related medical emergencies and hospital treatments have doubled since 1997.
In some parts of the country the rise is even steeper. The worst areas include the region formerly covered by Cheshire and Merseyside Strategic Health Authority, where 742 young people were treated last year, a rise of more than 25% in just a year. In Northumberland, Tyne and Wear, the number went up by a quarter.
By contrast, some southern health authorities experienced an improvement. In Bedfordshire and Hertfordshire, for example, there were only 119 cases, a fall of 30%.
In addition to the figures for children and teenagers, the Department of Health data also show that the number of people aged 18 and over treated for alcohol-related illness has gone up from 124,925 to 253,603 since 1997, a rise of more than 100%.
The data, released in a written answer, appear to contradict the government’s claims that the liberalisation of pub opening and supermarket off-sales time would lead to more responsible drinking. They bear out research published earlier this year by the British Association for Emergency Medicine, which found an increase in alcohol-related injuries treated in hospital among all age groups since the change to the drinking laws.
Ahead of its launch of 24-hour opening in November 2005, the government assured voters that there would be tougher controls on underage drinking.
It announced on-the-spot fines for children buying alcohol and tougher penalties for staff serving them.
Tessa Jowell, the culture secretary, said at the time: “The result will be more freedom for responsible adults and tougher treatment for the yobbish minority.”
Labour’s approach to teenage drinking has not always lived up to the responsible image that it likes to project.
In the run-up to the 2001 general election, the party sent text messages to first-time voters telling them, “Don’t give a XXXX for last orders? Vote Labour”. This was an allusion to advertisements for Castlemaine XXXX, the Australian beer.
Dr Gray Smith-Laing, a consultant at the Medway Maritime hospital in Gillingham, Kent, who treats patients with liver disease, said last week: “What we’re seeing is the numbers going up, the age coming down.
“The idea that (24-hour opening) just smooths out the drinking and people drink the same amount over a longer period of time is complete rubbish.”
The Department of Health says that levels of binge drinking have peaked and new facilities such as walk-in centres could explain the growth in treatment for drink-related injuries.
The department said yesterday: “The increased attendances at A&E departments, as seen in recently published figures, began some years ago. Evidence suggests that increased rate of growth of attendances predates the change in licensing laws by several years. In fact, this year growth has actually slowed.”

SOURCE: POSTED BY ALCOHOLICS ANONYMOUS UK AT 7:50 AM MON 25.12.06

Whether families benefit from alcohol treatment as well as the patients has rarely been studied. A new US analysis has demonstrated that they do, positioning alcohol treatment as also contributing to child and family welfare policy agendas.

The patients were 301 men living with female partners (all but a few were married) and seeking treatment at two US outpatient alcoholism clinics. Therapy was 12-step oriented with no particular emphasis on marital or family systems. How patients and their families fared was compared against men and women drawn from a national sample
closely matched to each patient and partner, but with no known serious drinking problems.

At treatment entry two-thirds of patients and their partners reported serious relationship problems, virtually all reported verbal aggression, and over half violence. Among the 125 couples with 4–16-year-olds at home, the mother’s reports indicated that 26% exhibited clinically significant behavioural or psychological problems. The proportions of
couples reporting violence or high levels of verbal aggression, and the frequency and severity of violence, fell significantly and substantially from the year before treatment to the year after it had ended
Severe violence (hitting or threatening with a weapon), experienced before treatment by a fifth of the women and a quarter of the men, became a relative rarity, affecting 5–6% of respondents

A similar analysis of the sub-sample with children found that the proportion of children exhibiting clinically significant problems was halved from before treatment to the year after it had ended and the frequency/extent ofthose problems also fell. On both measures and regardless of whether the father had relapsed, the patients’ children were now no worse off than children in the comparison families.
Post-treatment aggression and child welfare outcomes improved more when the patient had sustained their remission, but also improved among patients who relapsed.

In context Earlier studies found similar improvements, but the featured study is the first to do so with an adequate sample size, before and after treatment measures, and a non-alcoholic comparison sample. One earlier study found improvements in child functioning and marital harmony following cognitive-behavioural therapy focused on the male substance user, but these were greater and more lasting if the programme had included couples therapy sessions.

In general it seems that intervening with one family member (whether the problem substance user or not) affects the rest of the family, but impacts are greater when interventions address both the user and their family. Without an untreated comparison group of alcoholics, the featured study could not prove that treatment contributed to the improvements, but this seems highly likely.

Practice implications Though the focus has been more on users of illegal drugs, the welfare of the children of substance users has been highlighted in Britain by recent official reports which recognize that effective treatment of the parent can have major benefits.
Couples and family-based treatments, or patient-focused treatments which at least involve the family, have the greatest impacts on children and on marital harmony. Such services need to be sustained, but where they are unavailable or unacceptable to the families, providers and commissioners can nevertheless expect normal patient focused alcohol treatments to contribute to the reduction of domestic violence and to help intercept the creation of a new generation of
troubled youngsters.

Source: Drug & Alcohol Findings 2006

Using teacher therapists to identify problem personality traits in teenagers, and help them understand their behaviour, could be the key to stopping them binge drinking and taking drugs.
Adolescent alcohol consumption has more than doubled in the past decade and 15% of pupils reported taking drugs last year.
Addiction experts believe prevention is the key – stopping young people abusing drink and drugs before they start, instead of simply treating the addiction once it has taken hold.
Researchers at the Institute of Psychiatry at King’s College, London, asked more than 1,000 13-year-olds at secondary schools in London to answer a range of questions about their personalities.
They were looking for pupils with four problem personality traits: negative thinking, anxiety, impulsiveness and sensation seeking.
Half of those teenagers were then given two tailored therapy sessions – one 90 minutes long, the second an hour. In small groups teenagers with particular personality traits were encouraged to explore their personalities – including strengths and difficulties.
They were encouraged to think about other ways to deal with the risks associated with that behaviour – techniques they hope the teenagers will then use when they come face to face with drink or drugs.
“It’s about coping with the trait rather than changing the personality – in no way do we ever suggest they stop being who they are or change who they are,” says Dr Patricia Conrod, Consultant Clinical Psychologist at King’s College.
“It’s changing how it is they’re coping with who they are and perhaps capitalising on some of the more positive sides of the trait and learning to manage some of its more difficult sides.”
The results, they say, speak for themselves – one study of 13 to 16-year-olds led to a 40% reduction in binge drinking and cut the chance of teenagers taking cocaine by 80%. It is the first school based programme outside the US to successfully prevent alcohol uptake and misuse in teenagers.
Students asked to give feedback about the sessions told the researchers they helped with controlling anger and dealing with negative thinking.
A second trial then looked at whether ordinary teachers, with no psychiatric training, could be taught to deliver the sessions.
Focusing on more than 20 secondary schools and another thousand pupils, it found that with little training: a three day workshop followed by three hours of supervised practice; teachers could do as good a job as the professionals.
Latest figures show that alcohol misuse currently costs the NHS around £2.7bn a year. Charities say as successful as treating an addiction can be, most do begin in adolescence, hence the need to attack the problem before it even exists.
“Prevention is important because we need to stop people progressing to much severer problems later in life,” says Nick Barton, the Chief Executive of Action on Addiction, who helped fund the study.
“We find for instance in our treatment centres that when we assess drinking or drug use history, that very often the onset was way back in adolescence, sometimes as young as 11 but certainly the period between 11 and 16 was when the first attraction to substance use took hold.”
The researchers believe this programme could be delivered with just two well trained counsellors per borough who would teach school staff how to lead the sessions.
It will cost money, they say, but in the long run a little bit of investment now to stop another generation of binge drinkers could save the NHS millions in the future.

Source: http://www.bbc.co.uk/news/health 25th August 2010

Scientists at the University of Liverpool have found that high levels of a stress hormone in recovering alcoholics could increase the risk of relapse.

The study showed that cortisol, a hormone produced by the adrenal gland in response to stress, is found in high levels in chronic alcoholics, as well as those recovering from the condition.

Researchers found that this could result in impaired memory, attention and decision-making functions, which could decrease the patient’s ability to engage with treatment.

Chronic alcoholism is a disabling addictive disorder, characterised by compulsive and uncontrolled consumption of alcohol despite the negative effects it has on health, relationships and social standing. Alcohol damages almost every organ of the body including the brain where it causes memory loss and impairs decision-making and attention span.

Cortisol plays an important role in the regulation of emotion, learning, attention, energy utilization, and the immune system.

The research showed that high levels of this hormone are present in alcoholic patients and continue to be elevated during withdrawal from alcohol and after long periods of abstinence.

Lead author of the review, Dr Abi Rose, from the School of Psychology, Health and Society at the University of Liverpool, said: “Both drinking and withdrawal from alcohol can affect cortisol function in humans.

“Cortisol dysfunction, including the high levels of cortisol observed during alcohol withdrawal, may contribute to the high rates of relapse reported in alcohol dependence, even after many months of abstinence.

“Drugs targeting the effects of cortisol in the brain might reduce the chances of relapse and reduce the cognitive impairments that interfere with treatment.”

The study is published in Alcoholism: Clinical & Experimental Research. The research is in collaboration with Kings College London, University of Bern, and the University of Kentucky.

Source: www.clickliverpool.com 26.09.2010

Addicts require support from other recovering addicts, said the study.
Researchers believe they have identified some of the critical factors that determine whether alcoholics and heroin users can recover.
A study of more than 200 people in Glasgow found that spending time with other recovering addicts made success more likely.
Another predictor of success was whether addicts had something else in their lives to focus on, such as work.
The findings are due to be discussed at a conference in Glasgow.
The research was led by Dr David Best, a reader in criminal justice at the University of the West of Scotland.
“We found that the quality of life maintained by people in methadone maintained recovery wasn’t as good as for people in abstinent recovery” said Dr David Best Researcher He told the BBC’s Good Morning Scotland programme: “Addiction becomes an all-consuming and all-encompassing thing for people “In order for them to meaningfully sustain a recovery, it means it’s not sufficient to have just clinical interventions.
“There have to be a range of replacement activities and the more socially and community-based they are – including things like volunteering, parenting, education and training and obviously working – the more that void is filled and the more successfully individuals manage to build up an architecture of life that replaces that time spent in active addiction.”
The study also considered the role that methadone played in recovery.
Dr Best said: “Certainly as far as our research was concerned, we found that the quality of life maintained by people in methadone maintained recovery wasn’t as good as for people in abstinent recovery.
“It fits with previous research that we’ve done which has shown that there are some long-term effects of methadone, particularly around cognitive functioning, which may act as a mechanism for blunting the aspiration and hope and quality of life.
“It doesn’t mean recovery’s not possible in methadone but there may be some limitations to the extent of it.”
The study, which marks the first Recovery Academy conference in the city, drew parallels between alcoholism and heroin addiction.
Researchers said few differences were noted in the paths to recovery.Community Safety Minister Fergus Ewing, one of the speakers at the conference, said: “The Scottish government’s national drugs strategy, the Road to Recovery, recently reconfirmed by the Scottish Parliament, provides the framework for a fundamental change in our approach to tackling problem drug use through a focus on recovery.
“The Recovery Academy conference, the first of its kind in Scotland, provides the perfect platform for assessing the progress that is being made through this enhanced focus.
“Recovery from serious drug addiction is possible and the research being presented today clearly enhances our knowledge of the challenges faced.”
The event, taking place at the city’s Woodside Halls, is part of the wider Recovery Weekend, which invites people dealing with the effects of addiction, their families and friends to gather in Glasgow to meet and share ideas.

Source: http://www.bbc.co.uk/news/uk-scotland 24th Sept.2010

Exposure to alcohol in the womb can have devastating physical and mental effects – and children in care often suffer disproportionately
Six out of 10 children in care are there because they were abused or neglected, and parental drinking is often a significant factor. But professionals are becoming increasingly aware that some of these children may be victims of alcohol misuse twice over. An estimated 7,000 children are born with foetal alcohol syndrome (FAS) in the UK each year and experts believe that a disproportionate number of them end up in care.
FAS is caused by drinking during pregnancy and falls under the umbrella of foetal alcohol spectrum disorders (FASD), which are characterised by lifelong brain damage and physical defects. The consequences include learning disabilities, hyperactivity, autistic traits and problems with social skills, language and memory.
Life chances
Gareth Crossman, executive director of external affairs at The Adolescent and Children’s Trust (Tact), a charity provider of adoption and fostering services, says: “Young people in care have some of the worst life-chances of children, generally. They are more likely to be homeless, have mental health problems and come into contact with the criminal justice system. These issues are compounded [by FASD] because they cannot interact with the world in the same way as the rest of us.”
FASD have so far failed to register on the government’s radar, suggesting a pressing need for more integrated working between health and social care. Dr Mary Mather, medical adviser to Tact’s foetally affected children’s service, says: “Here we are doing nothing, and we suspect we have a bigger problem than other countries because we have one of the highest rates of teenage pregnancy and binge drinking in Europe.”
Research suggests that lack of diagnosis and support leads to chronic “secondary disabilities” including clinical depression with a high risk of suicide. In theory FAS is easier to diagnose than other disorders on the spectrum because of its characteristic facial features – such as small eyes, a smooth philtrum above the lip and a thin upper lip – but it depends on digital facial photography and computer analysis which is not widely available.
“You need a documented history of involvement with alcohol before birth and obstetric and neonatal records and that’s difficult with children in care,” says Mather. “When a baby is being placed for adoption it is virtually impossible to be sure of the diagnosis.”
Frequent placement breakdowns are likely to be the result. Most referrals to the FASD clinic run by Surrey and Borders Partnership NHS Foundation Trust – the only NHS diagnostic clinic – have been for adopted or fostered children, says consultant psychiatrist Dr Raja Mukherjee. “[The carers] have parented normally before but found they were struggling with this child and have sought help. The thing that causes the biggest problem lifelong is not how you look, but how you behave.”
Addressing behaviour involves using consistent routines, simple language, repetition of instructions and rules, a structured environment and constant supervision – talking therapies do not work. And what needs to be remembered, says Mather, is that “these are not children who won’t, but children who can’t”.
The Adolescent and Children’s Trust: tinyurl.com/32hhm9w
Surrey and Borders NHS partnership NHS Trust: tinyurl.com/3x5gn5z

Source: www.guardian.co.uk September 2010

Both drinking and withdrawal from chronic drinking can raise circulating glucocorticoid levels, known as cortisol in humans and corticosterone in rodents. Prolonged and high concentrations of glucocorticoids can have damaging effects on neuronal function and cognition. Evidence shows that glucocorticoids are associated with neurotoxicity during abstinence after withdrawal from alcohol dependence (AD), and that glucocorticoid receptor antagonism may represent a pharmacological option for recovery.

A review of this evidence will be published in the December 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
“Prolonged and elevated levels of glucocorticoid hormones can damage or destroy neurons, and lead to an increased vulnerability to other situations that can damage neurons, such as raised excitatory amino acid activity,” explained A.K. Rose, a lecturer in psychology at the University of Liverpool and corresponding author for the review. “This can underlie loss of memory functions.”
“High levels of brain cortisol associated with stress have long been linked to deficits in neuronal function, which can be seen in aging,” added John Littleton, a professor in the department of pharmaceutical sciences at the University of Kentucky.
Among the review’s key points:
Brain glucocorticoid concentrations increase and glucocorticoid receptor occupancy decreases during prolonged abstinence after withdrawal from alcohol.
“Our evidence shows that brain concentrations of corticosterone remain raised for long periods after alcohol withdrawal, even after the blood concentrations return to normal levels,” said H.J. Little, a professor in addiction science at King’s College London and who conducted this research. “Furthermore, the corticosterone concentrations remained increased in rodent brains for up to two months, approximately five human years, following cessation of prolonged alcohol drinking.”
“One of the most important questions for research and treatment is why alcoholics can relapse after many months of abstinence,” observed Littleton. “Partly this can be attributed to the effects of conditioning in which ‘cues’ provoke craving for alcohol, as well as a ‘protracted withdrawal syndrome’ which includes anxiety, sleep disturbances, and general feelings of being unwell. Prolonged high levels of brain cortisol after withdrawal from alcohol may explain the strength of these cues, and many of the symptoms of protracted withdrawal.”
Increased glucocorticoid levels in the brain after alcohol treatment are associated with cognitive deficits seen during abstinence, affecting both treatment efficacy and quality of life.
“Cessation of drinking is clearly linked to cognitive deficits,” said Little. “For example, visuospatial learning can be worse in abstinent alcoholics than in those still intoxicated, and memory and learning deficits have been found in rats after alcohol withdrawal, but not during alcohol intake. Furthermore, greater neuronal degeneration has been reported after cessation of chronic alcohol intake than during its consumption, and multiple withdrawal episodes cause greater neuronal damage than a single withdrawal episode.”
“This point is important because cognitive deficits in alcoholics during attempted abstinence can interfere with treatment options such as ‘cognitive behavior therapy’ and also drug treatment,” said Littleton. “Drugs targeting the effects of cortisol in the brain might therefore both reduce the chances of relapse and reduce the cognitive deficits that interfere with treatment.”
Glucocorticoids are involved in the neuropathological consequences of AD.
“Animal and cell-culture research show very convincingly that cortisol/corticosterone can increase neurotoxicity associated with periods of alcohol withdrawal,” said Littleton. “Since the highest cortisol levels were found in the prefrontal cortex and hippocampus, this may explain why these areas are damaged in alcoholics. This makes the brain cortisol glucocortcoid receptors a potential target for prevention of alcohol-induced brain damage.”
“If cognitive impairments could be reduced, patients would be more likely to engage in, and thus benefit from, psychosocial treatments,” added Rose. “Better cognitive function coupled with better treatment engagement is likely to produce better treatment outcomes and quality of life. A person with greater cognitive function is likely to be more able to find work and re-build relationships.
“In summary,” said Littleton,” stress, the hypothalamo-pituitary adrenal axis, and cortisol are very important determinants of the natural history of alcoholism — affecting an individual’s drinking behavior, the effects on cognition and memory, and the likelihood of relapsing into alcoholism during abstinence. We can also see that hypotheses applicable to animals can now be applied to inform new human research.”
Add’l Contact: H.J. Little, Ph.D. hilary.little@sgul.ac.uk 44.207.848.0436 (England) King’s College London

Source: Alcoholism: Clinical & Experimental Research, 7 SEP 2010 DOI: 10.1111/j.1530-0277.2010.01298.x

Researchers at King’s College London’s Institute of Psychiatry say a personality-based intervention for substance abuse that was delivered by teachers was successful in reducing drinking rates, particularly binge drinking, among adolescents.

In the article titled “Personality-Targeted Interventions Delay Uptake of Drinking and Decrease Risk of Alcohol-Related Problems When Delivered by Teachers,” principal Investigator Dr. Patricia Conrod and colleagues evaluated 2,506 adolescents, with a mean age of 13.7, using the Substance Use Risk Profile scale; a 23-item questionnaire which assesses personality risk for substance abuse along four dimensions including sensation-seeking, impulsivity, anxiety-sensitivity, and hopelessness.

Of the 1,159 students identified by researchers as being at high risk for substance abuse, 624 received intervention as part of the Adventure Trial and a matched high risk group of 384 received no intervention. School based interventions consisted of two 90 minute group sessions conducted by a trained educational professional. In order to adequately evaluate the students, the teachers attended a 3-day rigorous workshop, followed by 4 hour supervision and feedback session. An 18 point checklist was used to determine whether the teachers demonstrated a good understanding of the aims and components of the programs.

Although the trial is designed to evaluate mental health symptoms, academic achievement, and substance use uptake over a 2 year period, the authors have focused their findings on the six month outcomes of drinking and binge-drinking rates, quantity by frequency of alcohol use, and drinking-related problems. Reporting on the efficacy of the intervention at six months, author and Trial Coordinator Maeve O’Leary-Barrett writes, “Receiving an intervention significantly decreased the likelihood of reporting drinking alcohol at follow-up, with the control group 1.7 times more likely to report alcohol use than the intervention group (odds ratio, 0.6).”

Furthermore, receiving an intervention also predicted significantly lower binge-drinking rates in students who reported alcohol use at baseline (odds ratio, 0.45), indicating a 55 percent decreased risk of binge-drinking in this group compared with controls. In addition, high-risk intervention-school students reported lower quantity by frequency of alcohol use and drinking-related problems compared with the non-treatment group at follow-up.

The Adventure Trial is the first to evaluate the success of the personality-targeted interventions as delivered by teachers. The findings at six months suggest that this approach may provide a sustainable school-base prevention program for youth at risk for substance abuse.

In the JAACAP article, Principal Investigator Dr. Patricia Conrod and colleagues comment on the success of their program by stating, “In-house personality-targeted interventions allow schools to implement early prevention strategies with youth most at risk for developing future alcohol-related problems and provide the potential for follow-up of the neediest individuals.”

Source: Journal of the American Academy of Child and Adolescent Psychiatry. Sept. 2010

A new study from the David Geffen School of Medicine at UCLA suggests that increasing cigarette taxes could be an effective way to reduce smoking among individuals with alcohol, drug or mental disorders.

The study, published online in the American Journal of Public Health, found that a 10 percent increase in cigarette pricing resulted in an 18.2 percent decline in smoking among people in these groups.

The findings demonstrate that increasing cigarette taxes could be a way to curb smoking, which is still the leading preventable cause of death in the United States, according to the study’s lead author, Dr. Michael Ong, an assistant professor of medicine in the division of general internal medicine and health services research at the Geffen School of Medicine.
“Whatever we can do to reduce smoking is critical to the health of the U.S.,” said Ong, who is also a researcher at UCLA’s Jonsson Cancer Center. “Cigarette taxes are used as a key policy instrument to get people to quit smoking, so understanding whether people will really quit is important.

Individuals with alcohol, drug or mental disorders comprise 40 percent of remaining smokers, and there is little literature on how to help these people quit smoking.”

Prior research on the effect of cigarette pricing on smoking, which had been conducted using information from 1991, suggested that individuals with mental illness were less likely than other individuals to quit due to price increases. Unlike that research, however, the current study expanded the research to include people with alcohol and drug disorders.

The researchers based their work on data from 7,530 individuals from the 2000-01 Healthcare for Communities Household Survey. Of those, 2,106 people, or 23 percent, had alcohol, drug or mental disorders during the previous year. Of that group, 43.8 percent were smokers — a much higher proportion than among rest of the population.

Though the researchers found that people with alcohol dependence did not cut down on cigarettes when prices rose, people with binge-drinking problems, substance-use disorders and mental disorders were significantly more likely to quit smoking if prices rose, as would occur with a cigarette tax increase.

While the study does suggest that increasing cigarette prices through taxation could reduce smoking among individuals with alcohol, drug or mental disorders, the authors note that further study is needed to determine if recent cigarette price increases have reduced smoking among individuals with such disorders, and whether the identified association is causal.

Source: http://www.sciencedaily.com/releases June 3, 2010

Neuropharmacologists ran clinical trials to find that a drug called topiramate is an effective therapeutic medication for decreasing heavy drinking and diminishing the physical and psychosocial harm caused by alcohol dependence.

The drug works by blocking the right amount of the feel good effects of alcohol (brought on by increased levels of dopamine), making drinking less enjoyable and thus reducing cravings and helping to stop heavy drinking.

Topiramate was also found to lower blood pressure and cholesterol levels which may lead to a decrease in heart disease in alcohol dependent patients.

Alcoholism affects over 17 million people. Without proper treatment, it’s a devastating disease that can ruin lives and relationships. A new therapy that comes in a pill is bringing new hope to alcoholics.

There was a time in Christine Flemming’s life when alcohol came before her kids.
“I can’t remember when my daughter was very little, because I was drinking so much,” said Flemming. “That affected me a lot.”

Flemming needed help, but traditional treatment methods didn’t work. Now she’s on a new kind of therapy in the form of a pill called topiramate. It has changed her life. “I can tell you that it cuts my cravings, and I don’t feel like I have to drink,” Flemming said. “I don’t feel like that’s something I need in my life and I have to do.”

Alcohol increases levels of dopamine, a chemical in the brain that makes us feel good. The drug works by blocking the right amount of the feel-good effects from alcohol to reduce cravings and help stop heavy drinking. During clinical trials, neuropharmacologists were surprised to learn it also lowers blood pressure and cholesterol levels, which may lead to a decrease in heart disease in alcohol dependent patients.

“Most of the morbidity due to alcoholism is caused by secondary effects of all these other systems, so to have a drug that begins to correct all those other physical abnormalities is extremely helpful,” said Bankhole Johnson, Ph.D., a Neuropharmacologist at the University of Virginia in Charlottesville, Va.

The drug helped improve Fleming’s health and end her dependence on alcohol. She cut her drinking from 15 beers a day to just three, so time with her kids is now a priority.
“It’s made a big difference,” Flemming said. “It’s made a really big difference, and I feel like I’m actually there for my family.”

Qualifying patients can find out how to receive the drug by contacting their primary care doctors.

WHAT IS TOPIRAMATE? Topiramate is a drug originally discovered in 1979. It is prescribed as an epilepsy medication and for migraine headaches. It is also used for a number of other purposes, including as a treatment for people with alcoholism.

Researchers believe that topiramate works in two ways. First, it reduces the release of dopamine that follows the consumption of alcohol. This reduces the positive feeling that people receive from alcohol, and thus reduce the incentive to drink. Second, topiramate interferes with the protein glutamate which normally excites dopamine neurons and again, lessening the ýfeel goodý effect of dopamine from alcohol.

WHAT IS ALCOHOL? Alcohol is created through the natural process of fermentation. This happens when yeast and sugar from vegetables and grains change the sugar into alcohol. When you drink alcohol, it is absorbed into your bloodstream, where it can affect the central nervous system, which is the control center for your entire body.

Alcohol slows down this control center with its sedative effect. In moderation it can reduce anxiety, but it also blocks some of the commands the brain sends to other parts of the body, so it alters your senses. That’s why, when drunk, people often have trouble walking, talking, and some may even “black out,” forgetting what they said or did. Drinking an excessive amount of alcohol can even be fatal.

Source www.ScienceDaily June 2010

Combining a randomised trial with a ‘real-world’ test, studies of the Dutch Drinking Less programme have gone further than any others to establish the beneficial impacts of web-based alcohol self-help interventions.

The study was a ‘real-world’ test of a promising Dutch internet-based self-help intervention for problem drinking.
A previous randomised trial employing the methodological safeguards possible in tightly controlled research (particularly the recruitment of a comparison group not given access to the intervention) had established that the intervention reduced drinking. At issue in the featured study was whether similar drinking reductions would be seen when the intervention was made freely available to the general public. If they were, then the assumption could be made that these too were caused by having access to the intervention.

Drinking Less is an on-line, interactive programme with no personal therapist input. Aimed at risky drinkers among the general adult population, the intervention is based on principles derived from motivational interviewing, cognitive-behavioural therapies and self-control training. Its home page offers links to alcohol-related information, treatment services, a discussion forum, and the

Drinking Less self-help programme, the core of the intervention. Over a recommended six weeks (though this is entirely up to the user) the programme guides visitors in preparing to change their drinking, setting goals , implementing change, and finally sustaining it, preferably by drinking within recommended limits.

The earlier trial had found that six months later, at least 17% of adult problem drinkers randomly allocated to this intervention had reduced their drinking to within Dutch guidelines, compared to just 5% allocated to an on-line alcohol education brochure. Before the study, both groups had averaged about 55 UK units a week.

At follow-up, the Drinking Less group had cut consumption to about 36 UK units a week, but the brochure group had barely changed.

The featured study monitored what happened when over 10 months spanning 2007 and 2008 the web site was advertised to the Dutch public. During this time round 27,500 people visited the site, of whom 1625 signed up for the self-help programme, accessing it on average 23 times.

Typically they were well educated, employed, middle-aged men. On average they drank about 50 UK units a week, and nearly all who completed the on-line AUDIT screening questionnaire scored in a range indicative of alcohol abuse or dependence.
During the first seven of the 10 months, 378 of site visitors who signed up to the Drinking Less programme also agreed to participate in research to assess its impact. On average they drank roughly the same amount (95% exceeded Dutch guidelines) as all 1625 who signed up and were also similar in age, sex, employment, and motivation to change.

Despite some statistically significant differences, they were also broadly similar to participants in the earlier randomised trial. Over 8 in 10 had never received professional help for their drinking. A few weeks later a survey suggested that after signing up, nearly 9 in 10 went on to use the programme, though generally only a few times.
Of the 378 in the baseline sample, 153 responded to an on-line follow-up survey six months later. Before signing up to the programme, just 4% had confined their drinking within Dutch guidelines; six month later, 39% did so. They had also nearly halved their average consumption from 50 UK units to 27. On the ‘fail-safe’ assumption that the intervention had no impact on people who were not followed up, still the drinking reductions were statistically significant; from 5%, the proportion drinking within guidelines rose to 19%, and consumption fell from 51 UK units to 42.

Next the analysts compared these results with those from the six-month follow-up in the randomised trial. Based only on respondents to the follow-up surveys, and adjusting for differences between the samples, in the ‘real-world’ test over twice as many (unadjusted figures 36% v. 19%) people moved to drinking within Dutch guidelines. When the assumption was made that in both trials the intervention had no impact on people not followed up, the figures still favoured the ‘real-world’ test (15% v. 10%), but the difference was no longer statistically significant.

The researchers concluded that the featured study had shown that the benefits established by the randomised controlled trial would be sustained when the intervention was made routinely and generally available to the public. The expected throughput of 3000 Drinking Less programme users a year would amount to nearly 3% of the country’s problem drinkers who would otherwise not have received professional help. Probably because they require the drinker to take the initiative and visit the site, such interventions reach people who, compared to the totality of problem drinkers, are more likely to be women, employed, highly educated, and motivated to change their drinking. Given its low cost per user, this type of intervention seems to have a worthwhile place in a public health approach to reducing alcohol-related problems.

Though only a minority of site visitors may sign up for web-based alcohol programmes, nevertheless the numbers engaged can be very large, and the risk-reductions seem of the order typical in studies of brief advice to drinkers identified in health care settings. In these settings screening programmes typically identify people who are not actually seeking help for drinking problems – ‘pushing’ them towards intervention and change – while web sites ‘pull’ in people already curious or concerned about their drinking. As such these two gateways can play complementary roles in improving public health and offering change opportunities to people who would not present to alcohol treatment services. However, in Britain and elsewhere, both tactics reach only small fractions of the population who drinking excessively, leaving the bulk of the public health work to be done by interventions which drinkers generally cannot avoid and do not have seek out, such as price increases and availability restrictions.

With its combination of a randomised trial and a ‘real-world’ test, the featured research programme has gone further than any other in establishing the beneficial impacts of web-based alcohol interventions. However, largely because many site users do not complete research surveys, it remains impossible to be sure that the results seen in such studies will be replicated across the entire usership of the sites. Details below.

Strengths and limitations of the featured study
The featured study’s combination of a randomised trial with all its methodological safeguards, and a ‘real-world’ trial approximating normal conditions, affords what seems to be the best indication to date of the contribution web-based self-help interventions could make to reducing heavy drinking and associated health risks. However, its twin pillars are weakened by the fact that many people either did not join the studies or did not supply follow-up data; those who did may not have been typical of all the people who might access such sites.

In the randomised trial, 40% of the baseline sample did not complete the six-month follow-up survey, and in the featured study, nearly 60%. Though on the measures taken by the study the respondents generally seemed typical of the baseline sample, clearly something was sufficiently different to cause them to respond while the others did not. In both studies this problem was catered for by assuming that non-responders were also non-changers. Though this almost certainly underestimated the impact of the intervention, still in both there remained significant and worthwhile improvements.

What could not be catered for in either study was the degree to which people who join such studies differ from the much greater number who would use the web sites, but decline participation in research. This problem was especially apparent in the featured study, in which it seems that around 6% of site visitors signed up for the self-help programme. Of these, perhaps a third or slightly more of the people who signed up for the programme during the relevant period also agreed to participate in the research. In some important ways (including amount drunk and motivation to change) they seemed similar to the bulk of programme sign-ups, though the researchers suspect they were more likely to have engaged with the programme.

Opening more doors to change for more people
A review of computer-based alcohol services for the general public has rehearsed the advantages: immediate, convenient access for people (the majority in developed nations) connected to the internet; consequently able to capitalise on what may be fleeting resolve; anonymous services sidestep the embarrassment or stigma which might deter help-seeking; such services are available to people unwilling or less able to talk about their problems to a stranger; generally they are free and entail no travel costs or lost income due to time off work; very low operating cost per user if widely accessed; easily updated.

In consumption terms, the drinking problems of web site users are comparable to those of drinkers who seek treatment, yet few have received professional help, perhaps partly because their higher socioeconomic status and greater resources have enabled them to restrict the consequential damage. People who actually engage with web-based assessments of their drinking problems have more severe problems than those who just visit and leave. Including the randomised trial which paved the way for the featured study, the review found eight studies which evaluated the effectiveness of computer-based interventions for the general public.

In all but one the users significantly improved on at least one of the alcohol-related measures recorded by the studies.
A particular role for alcohol self-help sites may be to offer an easy, quick and accessible way to for drinkers to actualise their desire to tackle their problems, especially when that desire is allied with the resources to implement and sustain improvements without face-to-face or comprehensive assistance. After conducting the Project MATCH trial, some of the world’s leading alcohol treatment researchers argued that “access to treatment may be as important as the type of treatment available”. The implication is that in cultures which accept ‘treatment’ as a route to resolving unhealthy and/or undesirable drinking, having convincing-looking and accessible ‘treatment doors’ to go through may be more important than what lies behind those doors, as long as this fulfils the expectations of the client or patient. This is likely to be especially the case for people who retain a stake in conventional society in the form of marriages, jobs, families, and a reputation to lose. These populations – the kind the featured study suggests are attracted to self-help alcohol therapy web sites – have more of the ‘recovery capital’ resources needed to themselves do most of the work in curbing their drinking.

The British Down Your Drink site
The best known British alcohol self-help web site is the Down Your Drink site run by a team based at University College London, an initiative originally funded by the Alcohol Education and Research Council and now by the Medical Research Council’s National Prevention Research Initiative. In 2007 this was revised to offer set programmes from a one-hour brief intervention to several weeks, but also to generally give the user greater control over the use they made of the site. The approach remained based on principles and techniques derived from motivational interviewing and cognitive-behavioural therapies.

The previous version had been structured as six consecutive modules to be accessed weekly. An analysis of data provided by the first 10,000 people who registered at the site after piloting ended in September 2003 revealed that most were in their 30s and 40s, half were women, nearly two-thirds were married or living with a partner, just 4% were unemployed, and most reported occupations from higher socioeconomic strata.

As an earlier study commented, site users were predominantly middle class, middle aged, white and European. Six in 10 either did not start the programme, or completed just the first week. About 17% completed the six weeks. Of these, 57% returned an outcome questionnaire. Compared to their pre-programme status, on average they were now at substantially lower risk, and functioning better and living much improved lives.
The sample had been recruited over about 27 months, a registration rate of about 4500 a year. By way of comparison, in England during 2008/09, around 100,000 adults were treated for their alcohol problems at conventional services. User profile and site usage had been similar during the earlier pilot phase. Results from surveys sent to pilot programme completers indicated that three quarters had never previously sought help for their drinking.

Source: Published in Findings 19 May 2010 Alcoholism: Clinical and Experimental Research: 2009, 33(8), p. 1401–1408

How serious is the child and teenage alcohol problem in your area?

More than 20 children and teenagers are being treated in hospital every day for alcohol-related illnesses, including mental disorders, poisoning and liver disease, according to newly released official data.

The figures, labelled “staggering” by one of Britain’s most senior doctors, show that in the year 2005-6, during which Labour introduced 24-hour drinking, the number of under-18s seeking treatment for alcohol-related health problems leapt by 13% to 8,894, an average of 24 a day.

The research, released in parliament by Caroline Flint, the health minister, shows that the number treated has gone up by 33% since Labour came to power in 1997.

Professor Ian Gilmore, president of the Royal College of Physicians, said: “This is a staggering rise and it is only the tip of the iceberg.
“Drinks sold by supermarkets and off-licences are cheaper than ever, and those shops have been at the front of the queue for 24-hour licences, so it has never been more available.

“The younger they drink, the more likely they are to have alcohol-related problems later in life. It is now commonplace to see men and women in their twenties with end-stage alcoholic liver damage.”
The disease figures released by Flint do not include those people treated for injuries sustained in incidents such as drunken fights or drink-driving.

Separately, the government has released figures for patients treated for alcohol-related conditions in accident and emergency wards, showing that alcohol-related medical emergencies and hospital treatments have doubled since 1997.

In some parts of the country the rise is even steeper. The worst areas include the region formerly covered by Cheshire and Merseyside Strategic Health Authority, where 742 young people were treated last year, a rise of more than 25% in just a year. In Northumberland, Tyne and Wear, the number went up by a quarter.
By contrast, some southern health authorities experienced an improvement. In Bedfordshire and Hertfordshire, for example, there were only 119 cases, a fall of 30%.

In addition to the figures for children and teenagers, the Department of Health data also show that the number of people aged 18 and over treated for alcohol-related illness has gone up from 124,925 to 253,603 since 1997, a rise of more than 100%.
The data, released in a written answer, appear to contradict the government’s claims that the liberalisation of pub opening and supermarket off-sales time would lead to more responsible drinking.

They bear out research published earlier this year by the British Association for Emergency Medicine, which found an increase in alcohol-related injuries treated in hospital among all age groups since the change to the drinking laws.

Ahead of its launch of 24-hour opening in November 2005, the government assured voters that there would be tougher controls on underage drinking.
It announced on-the-spot fines for children buying alcohol and tougher penalties for staff serving them.
Tessa Jowell, the culture secretary, said at the time: “The result will be more freedom for responsible adults and tougher treatment for the yobbish minority.”

Labour’s approach to teenage drinking has not always lived up to the responsible image that it likes to project.
In the run-up to the 2001 general election, the party sent text messages to first-time voters telling them, “Don’t give a XXXX for last orders? Vote Labour”. This was an allusion to advertisements for Castlemaine XXXX, the Australian beer.

Dr Gray Smith-Laing, a consultant at the Medway Maritime hospital in Gillingham, Kent, who treats patients with liver disease, said last week: “What we’re seeing is the numbers going up, the age coming down.

“The idea that (24-hour opening) just smooths out the drinking and people drink the same amount over a longer period of time is complete rubbish.”
The Department of Health says that levels of binge drinking have peaked and new facilities such as walk-in centres could explain the growth in treatment for drink-related injuries.

The department said yesterday: “The increased attendances at A&E departments, as seen in recently published figures, began some years ago. Evidence suggests that increased rate of growth of attendances predates the change in licensing laws by several years. In fact, this year growth has actually slowed.”

SOURCE: POSTED BY ALCOHOLICS ANONYMOUS UK AT 7:50 AM MON 25.12.06

An Evaluation of the Kids, Adults Together Programme (KAT)

INTRODUCTION
A key influence on the timing of young people’s first alcohol use is the family (Spoth et al. 2002) and a number of substance misuse prevention programmes (mainly in the USA) have tried to influence families. Most are based in schools, which potentially provide an efficient way to reach large numbers of young people and their families (Bryan et al. 2006). However, in practice, school-based initiatives have not always managed to engage significant numbers of parents (Lloyd et al. 2000; Rothwell et al. 2009; Stead et al. 2007; Ward and Snow 2008).
This report describes the findings from an exploratory evaluation of a new school-based alcohol misuse prevention programme – Kids, Adults Together (KAT), which engaged with parents as well as children. The programme comprised a classroom component for children, a family fun evening, and a DVD. The research study evaluated the development and early implementation of KAT, and aimed to establish the theoretical basis for the programme. It explored implementation processes and acceptability, and identified plausible precursors of the intended long-term outcome which could be used as indicators of likely effectiveness.
METHODS
Mixed qualitative data-collection methods were used during two phases of evaluation. The first phase of the evaluation investigated how KAT had originated and developed; its relationship to existing evidence and theory; and its aims. Methods used were an analysis of thirty-two documents selected by the programme organizers and meant to provide an ‘audit trail’ of programme development up until the start of the evaluation; a literature search; and interviews with six members of the working group who had been involved in setting up the programme, the programme organiser and his assistant, the KAT DVD producer and the organiser of the Australian PAKT programme (on which KAT is based).
The second phase comprised observation of the classroom preparation and KAT family events in two pilot schools; focus groups with forty-one children; interviews with both head teachers and with teachers who delivered the classroom preparation; follow-up interviews with the programme organisers and six Working Group members; interviews with twelve parents who attended the KAT family events; and a questionnaire for parents of all 110 children who had been involved in the classroom preparation. There were two rounds of focus groups and parent interviews: the first as soon as possible after the KAT event at each school and the second months later.
Programme aims
The main aim of KAT was identified as reducing the number of children and young people who engaged in alcohol misuse. Exploration of the programme’s implementation suggested that family communication should be reaffirmed as its primary objective. This was consistent with the social development model (Catalano and Hawkins 1996) which links family communication with children’s alcohol-related behaviour later in life.
Acceptability
KAT achieved high levels of acceptability among pupils, parents and school staff. Parents enjoyed the fun evening, and thought it was delivered in an, engaging and non lecturing way. Participants thought it was good that the KAT programme had been run in the school setting, and felt that such work should be delivered to children at a young age. Staff in both pilot schools believed that the way in which the evening was promoted as an opportunity for parents to find out what their children had been working on helped avoid a perception that the fun evening was designed to lecture parents.
INITIAL IMPACT
Communication
The KAT programme’s most significant and persistent impact on communication was the effect on family conversations about parental drinking. Many children who thought their parents drank too much alcohol reported trying to change their (parents’) behaviour.
The classroom preparation was effective in promoting communication about alcohol issues amongst members of the class but outside the classroom, its effect was minimal, and until the work had culminated in the fun evening, few children said much at home about it. Most children were very keen to go to the fun evening, to show off their work, to see what it was like and to enjoy the refreshments and entertainment. Many put pressure on their parents to attend.
The fun evening acted as a catalyst for setting off conversations about what children had done in the classroom and activities during the evening. The DVD was effective in extending the influence of the programme beyond the school-based components.
Knowledge
Both children and parents reported having gained new knowledge about alcohol as a result of their involvement with the KAT programme.
Attitudes
There was little evidence that involvement in KAT (as a whole or its constituent components) had led to changes in parents’ or children’s attitudes to alcohol consumption. Overall the children held critical attitudes towards alcohol and the effects which its consumption might lead to. Most parents who were concerned about the dangers of alcohol and the use of alcohol by their children held pre-existing concerns or attitudes.
Awareness
KAT raised children’s and parents’ awareness of issues relating to alcohol and some parents had thought about their own drinking practices, particularly how drinking alcohol in front of their children could influence them.
Intention
Evidence from participants suggested that KAT had only a small effect on intentions regarding future behaviour. These intentions were often stimulated by specific aspects of the programme such as the DVD or leaflets in the goody bag.
Behaviour
There was evidence from some parents and children at both schools that drinking behaviour of parents and other family members had changed as a result of KAT. The effect was not confined to those who had attended the fun evening, suggesting that KAT was able to influence communication within wider networks of family and friends.
IMPLICATIONS
The report highlights five main findings from the evaluation of KAT:
1. KAT has demonstrated promise as an alcohol misuse prevention intervention through its short term impact on knowledge acquisition and pro-social communication with family networks
2. The interaction between the programme’s core components (classroom activities, family fun evening and the programme DVD/goody bag) appear to have been integral to the impact on knowledge acquisition and communication processes that occurred within participating families
3. The timing of KAT (its delivery to children In primary school Years 5 and 6) is appropriate both because it precedes the onset of drinking (or regular drinking), and because it engages families whilst they are still a key attachment and influence in young people’s lives
4. KAT achieved high levels of engagement and acceptability among parents, and this included some families with problems/support needs in relation to alcohol
5. Engagement levels among parents were higher among mothers than fathers. The research was not able to explore the in-depth experiences of those parents/carers who did not or could not attend the KAT fun evening
The following five recommendations are made for the future development and evaluation of KAT:
1. Further research is needed to refine and develop the theoretical model of how KAT works, whether short term changes in knowledge, communication and behaviour are sustained over the longer term, and how these processes might reduce alcohol misuse
2. KAT needs to be delivered and evaluated in different school contexts to further test its underpinning model, and explore the acceptability and local adaptation of the programme within these settings
Future research needs to explore in more detail the reach of the programme (including the engagement of fathers), examine what barriers to attendance might exist and put in place strategies to minimise them
3. Future stages of implementation should clarify if KAT specifically aims to reach families with problems/support needs in relation to alcohol, or whether it is intended as a primary prevention intervention for general school populations
4. It is important to address the support needs of children whose attempts to discuss issues raised by KAT (particularly around parental drinking) are rejected or not received positively by their parents

Source: http://www.aerc.org.uk/insightPages/libraryIns0070.html Alcohol Insight number 70

The brain’s nucleus accumbens (NAC) is a core region of the mesocorticolimbic dopaminergic system and is interconnected with the ventral tegmental area (VTA) and the prefrontal cortex. The mesocorticolimbic system is thought to be central to the reinforcing effects of many drugs and plays an important role in addiction. A new study has found that alcohol abuse elevated the expression of a distinct set of genes in the NAC and VTA, while nicotine blunted this effect in the VTA.

Results will be published in the July 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“In spite of their differences in pharmacology, alcohol and tobacco consumption are often intimately linked,” said Traute Flatscher-Bader, a postdoctoral research fellow at The University of Queensland and corresponding author for the study. “Nonetheless, the molecular mechanisms that underlie alcohol and nicotine abuse, and particularly their co-abuse, are still incompletely understood.”

“One thing that researchers have encountered is that it is often difficult to find ‘pure’ alcoholics, that is, alcoholics that only abuse alcohol and nothing else,” agreed Simon Worrall, director of postgraduate coursework programs in molecular biology at The University of Queensland. “Many alcoholics are poly-drug abusers, with the most common other drug being nicotine. Thus, many studies which have studied the effects of alcohol on the brain and other organs have been compromised because they have not taken account of the effects of nicotine addiction which is often superimposed on the effects of alcohol addiction.”

In the first part of the current study, Flatscher-Bader and her colleagues used DNA microarray technique to study the expression of many thousands of genes in the brains of non-smoking and smoking alcoholics and non-drinking smokers.

“We examined the impact of alcoholism and smoking on gene expression in the NAC in 20 chronic alcohol abusers and controls with and without recent smoking history,” said Flatscher-Bader. “The results revealed that in this brain region, the abuse of alcohol and nicotine had distinct effects on the expression of genes. In addition, altered expression of a number of genes was associated with both alcohol and nicotine abuse. Within the latter group was a set of genes which play a crucial role in a molecular pathway regulating cell structure.”

The researchers then went on to investigate in more detail the altered expression of six selected genes within the pathway regulating cell structure in two brain regions, using 30 cases comprised again of smoking and non-smoking controls and alcohol abusers. For this part of the study they used the method called “real time polymerase chain reaction.”

“This expanded investigation revealed that one of the genes, called RHOA, was elevated by alcohol abuse and its highest expression was evident in the smoking alcoholics in both brain regions,” said Flatscher-Bader. “The RHOA gene had previously been implicated in the initiation of tobacco smoking. In the NAC, the expression of a further four of the six selected genes was increased by alcohol abuse. Interestingly, the highest expression for each of the genes in the NAC was in the smoking alcoholics. In the other brain region called the VTA, alcohol abuse had a similar effect and elevated the expression of all six selected genes. In contrast to the NAC, however, concurrent smoking dampened the induction of five of these alcohol-sensitive genes in the VTA.”

“Many studies have analyzed the changes in gene expression in this brain system to try to untangle the molecular pathology of alcohol addiction,” said Worrall, “but this is amongst the first to take into account the effect of co-administration of nicotine with alcohol.

Flatscher-Bader stressed that there are several cell types in the brain and there are several steps between gene expression and impact on cell structure and function. “It has to be emphasized that our study is important as a first step in identifying molecular pathways underlying the effects of alcohol abuse and smoking and their co-joint abuse on the human NAC and VTA, “she said. “It now needs to be tested if our findings are, indeed, associated with changes to neuronal structure and function.”

“A better understanding of the molecular basis of withdrawal may help in the development of new treatments to ameliorate the symptoms,” added Dr Worrall. “Not many previous studies took into account the potential effects of nicotine addiction that may be superimposed on top of those from alcohol, so these results may help clinicians better use present therapy/drugs to treat patients abusing both alcohol and/or nicotine and may also lead to the development of new drugs.”

Source: www.medicalnewstoday.com 5.5.2010

Few studies can manage the painstaking analyses needed to identify what makes for successful counselling. This Swiss study broke new ground in dissecting why some brief interventionists had far better results than others with risky drinking A&E patients.
Abstract The featured report is one of several from a study of brief advice to heavy drinkers among injured adult patients attending a Swiss emergency department. Among 8439 patients, 1472 heavy drinkers were identified by a health screening survey, of whom 987 joined the study. They were randomly allocated to carry on as usual, to also be assessed by a researcher for about half an hour, or in addition to receive about 15 minutes of advice on drinking immediately after assessment. Adopting the style of motivational interviewing, this compared the patient’s drinking with national norms and led the patient to consider the pros and cons of their drinking and their readiness to change, culminating if appropriate in a setting a goal for change. Over the following year, this typical brief intervention format did not lead to greater reductions in drinking. About two-thirds of the patients continued to drink heavily regardless of advice and/or assessment.
During a period of the study and when patients allowed, intervention sessions were audio-taped. 97 sessions could be rated for the degree to which the counsellor adhered to a motivational style, and for comments from the patient indicative of their ability and willingness to change their drinking. Of these ratings, an initial analysis found that only the patient’s expressed degree of ability to change was related to later drinking; none of the counsellor’s behaviours was significantly linked. However, this analysis tried to separately link each behaviour (in)consistent with motivational interviewing’s principles with drinking. The possibility remained that combining these behaviours to characterise the counsellor’s overall style would yield significant results.
This was the approach taken in two further reports, one of which was the featured report. An earlier analysis established that counsellor comments consistent with the style of motivational interviewing were most likely to elicit positive statements about changing their drinking from the patient. The featured report related the same (and other) measures of counselling style to later drinking, limiting itself to interventions conducted by five counsellors with similar qualifications and experience and uniform preparatory training. Despite this they differed significantly in the their patients’ weekly drinking at the 12-month follow-up, and in the degree to which this represented an improvement on the amount they were drinking on entry to the study. At the extremes were one counsellor whose patients ended up drinking on average 18 UK units more per week, while another registered an average nine unit reduction.
These differences were at least partly accounted for by how far the counsellor was able to actually deliver the intervention in a motivational style. Drinking reductions were greater the more the counsellor demonstrated acceptance of the patient, conducted the intervention in the intended spirit, made more comments consistent versus inconsistent with a motivational approach, avoided inconsistent comments, elaborated on the patient’s comments rather than simply reflecting them back, and reflected back the patient’s comments with or without elaboration rather than asking questions. Empathy levels narrowly missed featuring among these strong and statistically significant links. These same attributes tended to even out the relationship between the patient’s expressed feelings of (in)ability to change and how much they did change their drinking over the 12 months. Highly skilled counsellors had good outcomes almost regardless of the patient’s doubts. The less skilled were effective mainly with patients who already expressed high levels of ability to change.
While accepting the need for replication in a larger study, for the authors their results suggested that an optimal combination of motivational interviewing skills results in better drinking outcomes, regardless of whether the patient is confident (or expresses confidence) in their ability to cut back. The pattern of results across all the reports from the study implies that training should focus on developing an overall approach consistent with motivational interviewing (with a particular focus on avoiding inconsistent behaviour) rather than on the frequent use of particular ‘micro’ techniques. Since training was equalised in the study, it also seems important to select staff with a ‘natural’ ability to adhere to the spirit of motivational interviewing when counselling patients.
These comments are more fully explained and referenced in the associated background notes. This study is one of the few in substance misuse to deeply address how therapists relate to clients in ways which promote positive change. It seems the first to depth-analyse interactions during a brief intervention which (from the patient’s point of view) unexpectedly addresses their drinking while they are seeking help for something else entirely. The implication is that in this situation, the impact of motivational interviewing with heavy drinkers depends on the ability of the counsellor to embody the spirit of the approach, not in minute or tick-box detail, but in broad-brush and consistent application. Given this spirit, as intended, patients in general respond not by defensively deflecting this uncalled-for advance, but by re-evaluating their drinking in ways which lead to a lasting reduction.
As intended by its creators, the findings show that true-to-type motivational interviewing can counter low motivation and doubts, elevating outcomes to near those of the most promising patients. While training doubtless played its part in developing this ability, still it left big differences between counsellors, who presumably varied in the degree to which they could implement what they learned. The more ‘trainable’ dimensions of the frequency of recommended types of comments were relatively uninfluential, the more nebulous ‘spirit’ dimensions more important. Despite expert training and supervision, the result was some therapists whose patients drank more than they did before, others whose patients drank less, a finding which turns the spotlight on staff recruitment. The implication is that without appropriate recruitment, much of the effort put in to training and supervision will be wasted.
The same message emerged from a study of motivational interviewing training which found that initial gains in skills had waned two months later. However, this was not the case for the addiction and mental health clinicians who, even before training, had been more proficient than the other trainees would be after training. Not only did these ‘natural experts’ start from a higher level, they went on to absorb and retain more of what they had learned.
How easy it is to find such people must be a concern. In the featured study all the counsellors were clinical psychologists educated to master degree level, trained by an experienced therapist and supervised throughout using actual client session recordings or observations. This exceptional combination of qualifications, training and ongoing support still resulted in just one of the therapists having a marked positive effect on drinking.
While these are important findings with echoes in other studies, inevitably they stand on a narrow and inadequate evidence base. Studies which probe deeply enough to make sense of what is going on in therapy require labour-intensive analyses, so tend to be limited to perhaps one site and a few therapists, by-products of studies designed to address the effectiveness not of therapists, but of therapies.
Particular caution is needed before assuming that the implications extend to substance misuse treatment. The dynamics in the emergency department are likely to be very different from those in substance misuse treatment clinics, whose patients have already acknowledged their problems and decided at least to give treatment a try. In this situation, the overwhelming influence is the strength of the patient’s resolution. Therapists can still make a noticeable and sometimes substantial difference, but generally more in terms of whether clients want to extend the relationship by staying in treatment, than in whether they change their substance use.
Among several less serious concerns, the featured study’s main weakness is the non-random allocation of patients to therapists, meaning varying caseloads might have influenced the therapists’ performances. However, this does not seem to account for the findings. Confidence in these and in their generalisability is increased by findings from different contexts with similar implications.
Across a range of caseloads, one review of how motivational interviewing works has highlighted (as the featured study did) the importance of therapists avoiding behaviours inconsistent with a motivational approach. Most relevant however are other brief intervention studies of patients not seeking treatment. These confirm that in such circumstances, some therapists are much more able than others to realise the potential of a motivational approach. Avoiding directive and confrontational behaviour seems particularly important with people who when they attended their GP, emergency department, or college, were not expecting their substance use to be addressed at all, let alone in such terms. Even patients who, while not seeking treatment, have volunteered for a check-up of their drinking habits, have reacted badly to such approaches. As in the featured study, other studies have also found that embodying the overall spirit of the approach is related to good outcomes, while the sheer quantity of ‘correct’ micro-behaviours is not. In one study the least effective of three therapists conducting motivational interventions for heavy drinking was also the one who most often used specific recommended techniques.
The dynamics of the therapist-patient encounter seem to differ in a treatment context. Like brief intervention studies, studies of patients actually seeking treatment for substance use problems have confirmed the importance of the overall spirit of the approach rather than micro measures of the frequency of correct therapist behaviours. However, they have been less clear about the damaging impact of behaviours inconsistent with a motivational approach. Within an overall supportive and accepting context, patients react well, or at least, not badly, to a degree of confrontation and caring concern, even if the patient’s permission has not been sought. With clients seeking help for a serious substance use disorder, there is more reason to show concern, be directive, and to warn about possible consequences. Patients who themselves are concerned and seeking direction might see the total absence of such comments from their therapists as withholding their true feelings, perhaps even as uncaring. For these patients the absence of a directive approach can be positively damaging, while those who like to see themselves as in control react badly to directive therapists.
Thanks for their comments on this entry in draft to Jacques Gaume, of the Alcohol Treatment Centre at Lausanne University Hospital. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Source: Findings Sept. 2009 Journal of Substance Abuse Treatment: 2009, 37, p. 151–159.

Combining a randomised trial with a ‘real-world’ test, studies of the Dutch Drinking Less programme have gone further than any others to establish the beneficial impacts of web-based alcohol self-help interventions.

Abstract

The study was a ‘real-world’ test of a promising Dutch internet-based self-help intervention for problem drinking. A previous randomised trial employing the methodological safeguards possible in tightly controlled research (particularly the recruitment of a comparison group not given access to the intervention) had established that the intervention reduced drinking. At issue in the featured study was whether similar drinking reductions would be seen when the intervention was made freely available to the general public. If they were, then the assumption could be made that these too were caused by having access to the intervention.

Drinking Less is an on-line, interactive programme with no personal therapist input. Aimed at risky drinkers among the general adult population, the intervention is based on principles derived from motivational interviewing, cognitive-behavioural therapies and self-control training. Its home page offers links to alcohol-related information, treatment services, a discussion forum, and the Drinking Less self-help programme, the core of the intervention. Over a recommended six weeks (though this is entirely up to the user) the programme guides visitors in preparing to change their drinking, setting goals , implementing change, and finally sustaining it, preferably by drinking within recommended limits.
The earlier trial had found that six months later, at least 17% of adult problem drinkers randomly allocated to this intervention had reduced their drinking to within Dutch guidelines, compared to just 5% allocated to an on-line alcohol education brochure. Before the study, both groups had averaged about 55 UK units a week. At follow-up, the Drinking Less group had cut consumption to about 36 UK units a week, but the brochure group had barely changed.
The featured study monitored what happened when over 10 months spanning 2007 and 2008 the web site was advertised to the Dutch public. During this time round 27,500 people visited the site, of whom 1625 signed up for the self-help programme, accessing it on average 23 times. Typically they were well educated, employed, middle-aged men. On average they drank about 50 UK units a week, and nearly all who completed the on-line AUDIT screening questionnaire scored in a range indicative of alcohol abuse or dependence.
During the first seven of the 10 months, 378 of site visitors who signed up to the Drinking Less programme also agreed to participate in research to assess its impact. On average they drank roughly the same amount (95% exceeded Dutch guidelines) as all 1625 who signed up and were also similar in age, sex, employment, and motivation to change. Despite some statistically significant differences, they were also broadly similar to participants in the earlier randomised trial. Over 8 in 10 had never received professional help for their drinking. A few weeks later a survey suggested that after signing up, nearly 9 in 10 went on to use the programme, though generally only a few times.
Of the 378 in the baseline sample, 153 responded to an on-line follow-up survey six months later. Before signing up to the programme, just 4% had confined their drinking within Dutch guidelines; six month later, 39% did so. They had also nearly halved their average consumption from 50 UK units to 27. On the ‘fail-safe’ assumption that the intervention had no impact on people who were not followed up, still the drinking reductions were statistically significant; from 5%, the proportion drinking within guidelines rose to 19%, and consumption fell from 51 UK units to 42.
Next the analysts compared these results with those from the six-month follow-up in the randomised trial. Based only on respondents to the follow-up surveys, and adjusting for differences between the samples, in the ‘real-world’ test over twice as many (unadjusted figures 36% v. 19%) people moved to drinking within Dutch guidelines. When the assumption was made that in both trials the intervention had no impact on people not followed up, the figures still favoured the ‘real-world’ test (15% v. 10%), but the difference was no longer statistically significant.
The researchers concluded that the featured study had shown that the benefits established by the randomised controlled trial would be sustained when the intervention was made routinely and generally available to the public. The expected throughput of 3000 Drinking Less programme users a year would amount to nearly 3% of the country’s problem drinkers who would otherwise not have received professional help. Probably because they require the drinker to take the initiative and visit the site, such interventions reach people who, compared to the totality of problem drinkers, are more likely to be women, employed, highly educated, and motivated to change their drinking. Given its low cost per user, this type of intervention seems to have a worthwhile place in a public health approach to reducing alcohol-related problems.
Though only a minority of site visitors may sign up for web-based alcohol programmes, nevertheless the numbers engaged can be very large, and the risk-reductions seem of the order typical in studies of brief advice to drinkers identified in health care settings. In these settings screening programmes typically identify people who are not actually seeking help for drinking problems – ‘pushing’ them towards intervention and change – while web sites ‘pull’ in people already curious or concerned about their drinking. As such these two gateways can play complementary roles in improving public health and offering change opportunities to people who would not present to alcohol treatment services. However, in Britain and elsewhere, both tactics reach only small fractions of the population who drinking excessively, leaving the bulk of the public health work to be done by interventions which drinkers generally cannot avoid and do not have seek out, such as price increases and availability restrictions.
With its combination of a randomised trial and a ‘real-world’ test, the featured research programme has gone further than any other in establishing the beneficial impacts of web-based alcohol interventions. However, largely because many site users do not complete research surveys, it remains impossible to be sure that the results seen in such studies will be replicated across the entire usership of the sites. Details below.

Strengths and limitations of the featured study

The featured study’s combination of a randomised trial with all its methodological safeguards, and a ‘real-world’ trial approximating normal conditions, affords what seems to be the best indication to date of the contribution web-based self-help interventions could make to reducing heavy drinking and associated health risks. However, its twin pillars are weakened by the fact that many people either did not join the studies or did not supply follow-up data; those who did may not have been typical of all the people who might access such sites. In the randomised trial, 40% of the baseline sample did not complete the six-month follow-up survey, and in the featured study, nearly 60%. Though on the measures taken by the study the respondents generally seemed typical of the baseline sample, clearly something was sufficiently different to cause them to respond while the others did not. In both studies this problem was catered for by assuming that non-responders were also non-changers. Though this almost certainly underestimated the impact of the intervention, still in both there remained significant and worthwhile improvements.
What could not be catered for in either study was the degree to which people who join such studies differ from the much greater number who would use the web sites, but decline participation in research. This problem was especially apparent in the featured study, in which it seems that around 6% of site visitors signed up for the self-help programme. Of these, perhaps a third or slightly more of the people who signed up for the programme during the relevant period also agreed to participate in the research. In some important ways (including amount drunk and motivation to change) they seemed similar to the bulk of programme sign-ups, though the researchers suspect they were more likely to have engaged with the programme.

Opening more doors to change for more people

A review of computer-based alcohol services for the general public has rehearsed the advantages: immediate, convenient access for people (the majority in developed nations) connected to the internet; consequently able to capitalise on what may be fleeting resolve; anonymous services sidestep the embarrassment or stigma which might deter help-seeking; such services are available to people unwilling or less able to talk about their problems to a stranger; generally they are free and entail no travel costs or lost income due to time off work; very low operating cost per user if widely accessed; easily updated. In consumption terms, the drinking problems of web site users are comparable to those of drinkers who seek treatment, yet few have received professional help, perhaps partly because their higher socioeconomic status and greater resources have enabled them to restrict the consequential damage. People who actually engage with web-based assessments of their drinking problems have more severe problems than those who just visit and leave. Including the randomised trial which paved the way for the featured study, the review found eight studies which evaluated the effectiveness of computer-based interventions for the general public. In all but one the users significantly improved on at least one of the alcohol-related measures recorded by the studies.
A particular role for alcohol self-help sites may be to offer an easy, quick and accessible way to for drinkers to actualise their desire to tackle their problems, especially when that desire is allied with the resources to implement and sustain improvements without face-to-face or comprehensive assistance. After conducting the Project MATCH trial, some of the world’s leading alcohol treatment researchers argued that “access to treatment may be as important as the type of treatment available”. The implication is that in cultures which accept ‘treatment’ as a route to resolving unhealthy and/or undesirable drinking, having convincing-looking and accessible ‘treatment doors’ to go through may be more important than what lies behind those doors, as long as this fulfils the expectations of the client or patient. This is likely to be especially the case for people who retain a stake in conventional society in the form of marriages, jobs, families, and a reputation to lose. These populations – the kind the featured study suggests are attracted to self-help alcohol therapy web sites – have more of the ‘recovery capital’ resources needed to themselves do most of the work in curbing their drinking.

The British Down Your Drink site

The best known British alcohol self-help web site is the Down Your Drink site run by a team based at University College London, an initiative originally funded by the Alcohol Education and Research Council and now by the Medical Research Council’s National Prevention Research Initiative. In 2007 this was revised to offer set programmes from a one-hour brief intervention to several weeks, but also to generally give the user greater control over the use they made of the site. The approach remained based on principles and techniques derived from motivational interviewing and cognitive-behavioural therapies.
The previous version had been structured as six consecutive modules to be accessed weekly. An analysis of data provided by the first 10,000 people who registered at the site after piloting ended in September 2003 revealed that most were in their 30s and 40s, half were women, nearly two-thirds were married or living with a partner, just 4% were unemployed, and most reported occupations from higher socioeconomic strata. As an earlier study commented, site users were predominantly middle class, middle aged, white and European. Six in 10 either did not start the programme, or completed just the first week. About 17% completed the six weeks. Of these, 57% returned an outcome questionnaire. Compared to their pre-programme status, on average they were now at substantially lower risk, and functioning better and living much improved lives. The sample had been recruited over about 27 months, a registration rate of about 4500 a year. By way of comparison, in England during 2008/09, around 100,000 adults were treated for their alcohol problems at conventional services. User profile and site usage had been similar during the earlier pilot phase. Results from surveys sent to pilot programme completers indicated that three quarters had never previously sought help for their drinking.

Source: Published in Findings 19 May 2010 Alcoholism: Clinical and Experimental Research: 2009, 33(8), p. 1401–1408

Combining a randomised trial with a ‘real-world’ test, studies of the Dutch Drinking Less programme have gone further than any others to establish the beneficial impacts of web-based alcohol self-help interventions.
Abstract The study was a ‘real-world’ test of a promising Dutch internet-based self-help intervention for problem drinking. A previous randomised trial employing the methodological safeguards possible in tightly controlled research (particularly the recruitment of a comparison group not given access to the intervention) had established that the intervention reduced drinking. At issue in the featured study was whether similar drinking reductions would be seen when the intervention was made freely available to the general public. If they were, then the assumption could be made that these too were caused by having access to the intervention.

Drinking Less is an on-line, interactive programme with no personal therapist input. Aimed at risky drinkers among the general adult population, the intervention is based on principles derived from motivational interviewing, cognitive-behavioural therapies and self-control training. Its home page offers links to alcohol-related information, treatment services, a discussion forum, and the Drinking Less self-help programme, the core of the intervention. Over a recommended six weeks (though this is entirely up to the user) the programme guides visitors in preparing to change their drinking, setting goals , implementing change, and finally sustaining it, preferably by drinking within recommended limits.
The earlier trial had found that six months later, at least 17% of adult problem drinkers randomly allocated to this intervention had reduced their drinking to within Dutch guidelines, compared to just 5% allocated to an on-line alcohol education brochure. Before the study, both groups had averaged about 55 UK units a week. At follow-up, the Drinking Less group had cut consumption to about 36 UK units a week, but the brochure group had barely changed.
The featured study monitored what happened when over 10 months spanning 2007 and 2008 the web site was advertised to the Dutch public. During this time round 27,500 people visited the site, of whom 1625 signed up for the self-help programme, accessing it on average 23 times. Typically they were well educated, employed, middle-aged men. On average they drank about 50 UK units a week, and nearly all who completed the on-line AUDIT screening questionnaire scored in a range indicative of alcohol abuse or dependence.
During the first seven of the 10 months, 378 of site visitors who signed up to the Drinking Less programme also agreed to participate in research to assess its impact. On average they drank roughly the same amount (95% exceeded Dutch guidelines) as all 1625 who signed up and were also similar in age, sex, employment, and motivation to change. Despite some statistically significant differences, they were also broadly similar to participants in the earlier randomised trial. Over 8 in 10 had never received professional help for their drinking. A few weeks later a survey suggested that after signing up, nearly 9 in 10 went on to use the programme, though generally only a few times.
Of the 378 in the baseline sample, 153 responded to an on-line follow-up survey six months later. Before signing up to the programme, just 4% had confined their drinking within Dutch guidelines; six month later, 39% did so. They had also nearly halved their average consumption from 50 UK units to 27. On the ‘fail-safe’ assumption that the intervention had no impact on people who were not followed up, still the drinking reductions were statistically significant; from 5%, the proportion drinking within guidelines rose to 19%, and consumption fell from 51 UK units to 42.
Next the analysts compared these results with those from the six-month follow-up in the randomised trial. Based only on respondents to the follow-up surveys, and adjusting for differences between the samples, in the ‘real-world’ test over twice as many (unadjusted figures 36% v. 19%) people moved to drinking within Dutch guidelines. When the assumption was made that in both trials the intervention had no impact on people not followed up, the figures still favoured the ‘real-world’ test (15% v. 10%), but the difference was no longer statistically significant.
The researchers concluded that the featured study had shown that the benefits established by the randomised controlled trial would be sustained when the intervention was made routinely and generally available to the public. The expected throughput of 3000 Drinking Less programme users a year would amount to nearly 3% of the country’s problem drinkers who would otherwise not have received professional help. Probably because they require the drinker to take the initiative and visit the site, such interventions reach people who, compared to the totality of problem drinkers, are more likely to be women, employed, highly educated, and motivated to change their drinking. Given its low cost per user, this type of intervention seems to have a worthwhile place in a public health approach to reducing alcohol-related problems.
Though only a minority of site visitors may sign up for web-based alcohol programmes, nevertheless the numbers engaged can be very large, and the risk-reductions seem of the order typical in studies of brief advice to drinkers identified in health care settings. In these settings screening programmes typically identify people who are not actually seeking help for drinking problems – ‘pushing’ them towards intervention and change – while web sites ‘pull’ in people already curious or concerned about their drinking. As such these two gateways can play complementary roles in improving public health and offering change opportunities to people who would not present to alcohol treatment services. However, in Britain and elsewhere, both tactics reach only small fractions of the population who drinking excessively, leaving the bulk of the public health work to be done by interventions which drinkers generally cannot avoid and do not have seek out, such as price increases and availability restrictions.
With its combination of a randomised trial and a ‘real-world’ test, the featured research programme has gone further than any other in establishing the beneficial impacts of web-based alcohol interventions. However, largely because many site users do not complete research surveys, it remains impossible to be sure that the results seen in such studies will be replicated across the entire usership of the sites. Details below.
Strengths and limitations of the featured study
The featured study’s combination of a randomised trial with all its methodological safeguards, and a ‘real-world’ trial approximating normal conditions, affords what seems to be the best indication to date of the contribution web-based self-help interventions could make to reducing heavy drinking and associated health risks. However, its twin pillars are weakened by the fact that many people either did not join the studies or did not supply follow-up data; those who did may not have been typical of all the people who might access such sites. In the randomised trial, 40% of the baseline sample did not complete the six-month follow-up survey, and in the featured study, nearly 60%. Though on the measures taken by the study the respondents generally seemed typical of the baseline sample, clearly something was sufficiently different to cause them to respond while the others did not. In both studies this problem was catered for by assuming that non-responders were also non-changers. Though this almost certainly underestimated the impact of the intervention, still in both there remained significant and worthwhile improvements.
What could not be catered for in either study was the degree to which people who join such studies differ from the much greater number who would use the web sites, but decline participation in research. This problem was especially apparent in the featured study, in which it seems that around 6% of site visitors signed up for the self-help programme. Of these, perhaps a third or slightly more of the people who signed up for the programme during the relevant period also agreed to participate in the research. In some important ways (including amount drunk and motivation to change) they seemed similar to the bulk of programme sign-ups, though the researchers suspect they were more likely to have engaged with the programme.
Opening more doors to change for more people
A review of computer-based alcohol services for the general public has rehearsed the advantages: immediate, convenient access for people (the majority in developed nations) connected to the internet; consequently able to capitalise on what may be fleeting resolve; anonymous services sidestep the embarrassment or stigma which might deter help-seeking; such services are available to people unwilling or less able to talk about their problems to a stranger; generally they are free and entail no travel costs or lost income due to time off work; very low operating cost per user if widely accessed; easily updated. In consumption terms, the drinking problems of web site users are comparable to those of drinkers who seek treatment, yet few have received professional help, perhaps partly because their higher socioeconomic status and greater resources have enabled them to restrict the consequential damage. People who actually engage with web-based assessments of their drinking problems have more severe problems than those who just visit and leave. Including the randomised trial which paved the way for the featured study, the review found eight studies which evaluated the effectiveness of computer-based interventions for the general public. In all but one the users significantly improved on at least one of the alcohol-related measures recorded by the studies.
A particular role for alcohol self-help sites may be to offer an easy, quick and accessible way to for drinkers to actualise their desire to tackle their problems, especially when that desire is allied with the resources to implement and sustain improvements without face-to-face or comprehensive assistance. After conducting the Project MATCH trial, some of the world’s leading alcohol treatment researchers argued that “access to treatment may be as important as the type of treatment available”. The implication is that in cultures which accept ‘treatment’ as a route to resolving unhealthy and/or undesirable drinking, having convincing-looking and accessible ‘treatment doors’ to go through may be more important than what lies behind those doors, as long as this fulfils the expectations of the client or patient. This is likely to be especially the case for people who retain a stake in conventional society in the form of marriages, jobs, families, and a reputation to lose. These populations – the kind the featured study suggests are attracted to self-help alcohol therapy web sites – have more of the ‘recovery capital’ resources needed to themselves do most of the work in curbing their drinking.
The British Down Your Drink site
The best known British alcohol self-help web site is the Down Your Drink site run by a team based at University College London, an initiative originally funded by the Alcohol Education and Research Council and now by the Medical Research Council’s National Prevention Research Initiative. In 2007 this was revised to offer set programmes from a one-hour brief intervention to several weeks, but also to generally give the user greater control over the use they made of the site. The approach remained based on principles and techniques derived from motivational interviewing and cognitive-behavioural therapies.
The previous version had been structured as six consecutive modules to be accessed weekly. An analysis of data provided by the first 10,000 people who registered at the site after piloting ended in September 2003 revealed that most were in their 30s and 40s, half were women, nearly two-thirds were married or living with a partner, just 4% were unemployed, and most reported occupations from higher socioeconomic strata. As an earlier study commented, site users were predominantly middle class, middle aged, white and European. Six in 10 either did not start the programme, or completed just the first week. About 17% completed the six weeks. Of these, 57% returned an outcome questionnaire. Compared to their pre-programme status, on average they were now at substantially lower risk, and functioning better and living much improved lives. The sample had been recruited over about 27 months, a registration rate of about 4500 a year. By way of comparison, in England during 2008/09, around 100,000 adults were treated for their alcohol problems at conventional services. User profile and site usage had been similar during the earlier pilot phase. Results from surveys sent to pilot programme completers indicated that three quarters had never previously sought help for their drinking.
Source: Published in Findings 19 May 2010 Alcoholism: Clinical and Experimental Research: 2009, 33(8), p. 1401–1408

Researchers have discovered that ¬consuming a very high amount of alcohol in a short time can cause irreversible damage. In the long run youngsters risk becoming absent-minded and forgetful.
Previous research found that high levels of alcohol act as a poison and prevent the brain working properly. Now scientists say that excess alcohol can actually destroy grey matter called the hippocampus, which stores and recalls events and forms mental images, known as spatial reasoning.
A US team gave alcohol for one hour a day to teenage macaque monkeys, who drank until they were drunk. Their brains produced fewer cells and suffered more neural degeneration than a control group. Last year, a survey of 35 countries found the UK had the third highest number of 15 and 16-year-olds with an alcohol problem. Girls were worse than boys.
Don Shenker, chief executive of Alcohol Concern, said the Government needed “to force the drinks industry to ensure consumers are aware of the dangers”.

Source: Daily Express 1st June 2010

The brain’s nucleus accumbens (NAC) is a core region of the mesocorticolimbic dopaminergic system and is interconnected with the ventral tegmental area (VTA) and the prefrontal cortex. The mesocorticolimbic system is thought to be central to the reinforcing effects of many drugs and plays an important role in addiction. A new study has found that alcohol abuse elevated the expression of a distinct set of genes in the NAC and VTA, while nicotine blunted this effect in the VTA.

Results will be published in the July 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“In spite of their differences in pharmacology, alcohol and tobacco consumption are often intimately linked,” said Traute Flatscher-Bader, a postdoctoral research fellow at The University of Queensland and corresponding author for the study. “Nonetheless, the molecular mechanisms that underlie alcohol and nicotine abuse, and particularly their co-abuse, are still incompletely understood.”

“One thing that researchers have encountered is that it is often difficult to find ‘pure’ alcoholics, that is, alcoholics that only abuse alcohol and nothing else,” agreed Simon Worrall, director of postgraduate coursework programs in molecular biology at The University of Queensland. “Many alcoholics are poly-drug abusers, with the most common other drug being nicotine. Thus, many studies which have studied the effects of alcohol on the brain and other organs have been compromised because they have not taken account of the effects of nicotine addiction which is often superimposed on the effects of alcohol addiction.”

In the first part of the current study, Flatscher-Bader and her colleagues used DNA microarray technique to study the expression of many thousands of genes in the brains of non-smoking and smoking alcoholics and non-drinking smokers.

“We examined the impact of alcoholism and smoking on gene expression in the NAC in 20 chronic alcohol abusers and controls with and without recent smoking history,” said Flatscher-Bader. “The results revealed that in this brain region, the abuse of alcohol and nicotine had distinct effects on the expression of genes. In addition, altered expression of a number of genes was associated with both alcohol and nicotine abuse. Within the latter group was a set of genes which play a crucial role in a molecular pathway regulating cell structure.”

The researchers then went on to investigate in more detail the altered expression of six selected genes within the pathway regulating cell structure in two brain regions, using 30 cases comprised again of smoking and non-smoking controls and alcohol abusers. For this part of the study they used the method called “real time polymerase chain reaction.”

“This expanded investigation revealed that one of the genes, called RHOA, was elevated by alcohol abuse and its highest expression was evident in the smoking alcoholics in both brain regions,” said Flatscher-Bader. “The RHOA gene had previously been implicated in the initiation of tobacco smoking. In the NAC, the expression of a further four of the six selected genes was increased by alcohol abuse. Interestingly, the highest expression for each of the genes in the NAC was in the smoking alcoholics. In the other brain region called the VTA, alcohol abuse had a similar effect and elevated the expression of all six selected genes. In contrast to the NAC, however, concurrent smoking dampened the induction of five of these alcohol-sensitive genes in the VTA.”

“Many studies have analyzed the changes in gene expression in this brain system to try to untangle the molecular pathology of alcohol addiction,” said Worrall, “but this is amongst the first to take into account the effect of co-administration of nicotine with alcohol.

Flatscher-Bader stressed that there are several cell types in the brain and there are several steps between gene expression and impact on cell structure and function. “It has to be emphasized that our study is important as a first step in identifying molecular pathways underlying the effects of alcohol abuse and smoking and their co-joint abuse on the human NAC and VTA, “she said. “It now needs to be tested if our findings are, indeed, associated with changes to neuronal structure and function.”

“A better understanding of the molecular basis of withdrawal may help in the development of new treatments to ameliorate the symptoms,” added Dr Worrall. “Not many previous studies took into account the potential effects of nicotine addiction that may be superimposed on top of those from alcohol, so these results may help clinicians better use present therapy/drugs to treat patients abusing both alcohol and/or nicotine and may also lead to the development of new drugs.”

Source: www.medicalnewstoday.com 5.5.2010

 Around 44 0000 people have been recorded as entering specialised drug treatment centres in Europe in 2008 in 29 countries; data mainly cover outpatient and inpatient treatment centers
 Most clients enter treatment on their own initiative or under the pressure of family and friends (43 %); 27 % go to drug treatment through health or social services, including other drug treatment centres; around 20 % are referred to treatment by the criminal justice system, and the remaining through other referral sources
 The most frequent reason for entering treatment in 2008 (or most recent year available), is the use of heroin (48 % of all drug users and around 200 000 people), followed by cannabis (21 % and around 85 000 people) and cocaine use, (17 % and around 70 000 people), use of stimulants other than cocaine (5 % and around 22 000 clients) and other drugs use, which include hypnotics and sedatives, hallucinogens, volatile and other substances
 Among those who have entered treatment for the first time in their life the proportion of heroin users is lower and that of cocaine, cannabis users and clients consuming stimulants other than cocaine (mainly amphetamine and methamphetamine) is higher
 Differences between countries are relevant with 18 countries reporting more than 50 % of primary opioid users among drug clients, 8 countries with more than 20 % of primary cannabis clients and 3 countries with more than 20 % of cocaine clients.
 Stimulants other than cocaine, which will be the subject of one of 2010 selected issue are concentrated in some countries, namely the Scandinavian countries (amphetamine), Czech Republic and Slovakia (methamphetamine)
 Clients are mainly males (4 males for every female), with a mean age 31 years (those who have entered treatment for the first time are on average 1 year younger)
 Most clients start their drug use before the age of 20, around one third of the clients inject their primary drug, and the frequency of use varies by the main drug (the highest proportion of daily users is found among opioid clients and the lowest among users of stimulants other than cocaine)
 Social conditions of drug users entering treatment are generally poorer than in the general population (education, living and labour conditions)
 Differences are reported by primary drug and by country regarding gender, age distribution and patterns of drug use

 Recent comparable data on young people’s use of alcohol and drug come largely from surveys of 15- to 16-year-old school students. The European School Survey Project (ESPAD) conducted surveys in 1995, 1999, 2003 and more recently, 2007. The 2007 survey (Hibell et al., 2009) provides comparable data from 25 EU Member States as well as Norway and Croatia. Five countries conducted their own school surveys in 2008 (Belgium-Flemish Community, Spain, Italy, Sweden, United Kingdom-England)
 The latest ESPAD survey data from 2007 reveal that the highest lifetime prevalence of cannabis use among 15- and 16-year-old school students is in the Czech Republic (45 %) (Figure EYE-1 part (ii)). High lifetime prevalence estimates, ranging from 26 % to 32 %, are also reported in Estonia, France, the Netherlands, the Slovak Republic and the United Kingdom.
 Increases in cannabis use occurred in a number of European countries between 1995 and 2003 but have, in general, come to a halt or decreased more recently. Seven countries mainly located in Northern and Southern Europe (Greece, Cyprus, Malta, Romania, Finland, Sweden, Norway) reported overall stable and low lifetime prevalence of cannabis use during the whole period. Other western European countries, as well as Croatia and Slovenia, have shown a significant increase of lifetime cannabis use up to 2003 and since then nine of these reported a decrease of more than three percentage points, two were stable and none reported an increase. In most of central and eastern Europe the increasing trend observed between 1995 and 2003 seems not to have been reversed yet. In this region, two out of eight countries report increases of more than three percentage points since 2003, six or more a stable situation and none a significant decrease. In the five countries that conducted national school surveys in 2008, all reported stable or lower lifetime prevalence of cannabis use than reported in 2007 (Table EYE-11).
 Increases in lifetime cannabis use between 1995 and 2003 in Europe were in some countries accompanied by increases in the prevalence of cigarette smoking among school students. Since 2003, both trends have reversed, suggesting a possible link between tobacco and cannabis smoking.
 Estimates of the prevalence of other drug use among school students are much lower than those for cannabis use. For example, lifetime prevalence of cocaine use among 15- to 16-year-old school students is between 1 % and 2 % in half of the 28 reporting countries. Most of the remaining countries report prevalence levels of between 3 % and 4 %, while Spain, France, and the United Kingdom report 5 %. Among the five countries that conducted school surveys in 2008, two reported a decrease of 1%, one reported an increase of 1%, and two reported no change since the last survey (Table EYE-11). However, caution is required interpreting trends with such low prevalence.
 In the countries conducting their own national school surveys, drug prevalence questions may be considered comparable to the ESPAD questions but other aspects of the method mean the data are not strictly comparable.
Source: EMDDA July 10 2010

Some people can drink a lot of alcohol without becoming addicted, and specific genes may help explain why, researchers say.
In a new study of Australian twins, scientists found that separate genes appear to be responsible, to some degree, for dependence on alcohol — addiction — and how much people drink. Understanding how these genetic factors work together should give researchers more insight into treatment of alcoholism in its various forms, said study co-author John B. Whitfield, a researcher at Royal Prince Alfred Hospital in Australia.
Alcoholism and alcohol consumption may appear to be similar, but researchers are increasingly studying them separately. Consumption refers to the amount of alcohol that someone drinks, while addiction refers to a person’s inability to go without a drink.
“The transition from social alcohol consumption to alcohol dependence is a gradual process, and it is often hard to notice it,” said Dr. Alexei B. Kampov-Polevoi, an assistant professor of psychiatry at Mount Sinai School of Medicine. “As a result, many alcoholics and their family members continue to think that a person ‘just drinks too much’ while this person already developed alcohol dependence and requires treatment.”
Whitfield and his colleagues examined statistics about alcohol use from three studies of Australian twins completed between 1980 and 1995. The number of twins in the studies declined from 8,184 in 1980 to 3,378 in 1995.
The findings appear in the August issue of Alcoholism: Clinical & Experimental Research.
The researchers found twins who were genetically similar were more likely to consume similar amounts of alcohol. According to the study, some genes affected both addiction and alcohol intake, while some just affected addiction.
“We found (as others have also found) that alcohol dependence is partly, but not entirely, due to genetic differences between people who are affected by it and those who are not,” Whitfield said. “We also found that variation in the amount of alcohol that people habitually drink is subject to genetic influence, and that there is some — but not complete — overlap between the genes affecting these two things.”
Howard J. Edenberg, professor of biochemistry and molecular biology at Indiana University, said the findings — that genes separately affect alcoholism and drinking — are “reasonable.” But “that is a long way from identifying individual genes that actually are involved,” said Edenberg, whose own research is looking into that area.
So what should ordinary folks take from this study? “There is no direct and new message for people with alcoholism in their families; they are at higher risk than average but this has been known for some time and there is only a statistical risk, not a certainty by any means,” Whitfield said. “The more positive message for such people, and the community at large, is that we are learning more about alcohol use and alcohol-related problems and their causes.”
Source : HealthDay News 18th August 2004

New research suggests that people who smoke and drink heavily are more at risk for oral cancer, the Researchers from King’s College in London, England, found an increase in oral cancer among men and women in their 20s and 30s who smoke and binge drink.

The researchers said that when tobacco smoke combines with alcohol, it produces dangerous levels of cancer-causing chemicals that attack the lining of the mouth.

“Our data show that smoking, drinking and poor diet are major risk factors, and that the younger people start smoking and drinking, the higher the risk,” said Newell Johnson, a professor of oral pathology at King’s College

Source: Daily Telegraph, London reported Nov. 9.2004

Scientists at Melbourne’s Howard Florey Institute have discovered a system in the brain that stops an alcoholic’s craving for alcohol, as well as prevent relapse once they have recovered from alcohol addiction.
________________________________________
The ‘Orexin’ system is a group of cells in a part of the brain called the hypothalamus. These cells produce Orexin, which was originally implicated in the regulation of feeding, but it soon became apparent that Orexin was also involved in the ‘high’ felt after drinking alcohol or taking illicit drugs.

In studies conducted with rats, Dr Andrew Lawrence and his Florey colleagues used a drug that blocked Orexin’s euphoric effects in the brain and the results were remarkable.
“In one experiment, rats that had alcohol freely available to them stopped drinking it after receiving the Orexin blocker.” Dr Lawrence said. “In another experiment, rats that had gone through a detox program and were then given the Orexin blocking drug, did not relapse into alcohol addiction when they were reintroduced to an environment in which they had been conditioned to associate with alcohol use.

“Orexin reinforces the euphoria felt when drinking alcohol, so if a drug can be developed to block the Orexin system in humans, we should be able to stop an alcoholic’s craving for alcohol, as well as preventing relapse once the alcoholic has recovered,” he said.
Dr Lawrence said that this research could also lead to treatments for eating disorders, such chronic over-eating, which leads to obesity. “Our research shows that alcohol addiction and eating disorders set off common triggers in the brain, so further investigations may uncover drug targets in the Orexin system to treat both conditions,” Dr Lawrence said.

The Florey scientists are now conducting multiple experiments to discover the precise circumstances that activate the Orexin system. “To explore this discovery further we are now investigating how different experimental paradigms and environmental situations impact on the Orexin system, which will hopefully pinpoint therapeutic drug targets,” Dr Lawrence said.
“Before a therapeutic Orexin-blocking drug can be developed, we need to ensure that it will be safe to use in the long-term and that issues surrounding a person’s compliance in taking the drug are considered,” he said.

According to the World Health Organisation, alcohol is one of the most widely used and abused substances in the world and causes as much, if not more death and disability as measles, malaria, tobacco, or illegal drugs.
Dr Lawrence and his colleagues were the first in the world to demonstrate the Orexin system’s involvement in alcohol addiction and their research paper was recently published in the prestigious British Journal of Pharmacology. Dr Lawrence’s paper was downloaded 658 times by researchers from around the world in the first three months of its publication, making it the most downloaded research paper in that issue and supporting the research’s importance.
The Howard Florey Institute is Australia’s leading brain research centre. Its scientists undertake clinical and applied research that can be developed into treatments to combat brain disorders, and new medical practices. Their discoveries will improve the lives of those directly, and indirectly, affected by brain and mind disorders in Australia, and around the world. The Florey’s research areas cover a variety of brain and mind disorders including Parkinson’s disease, stroke, motor neuron disease, addiction, epilepsy, multiple sclerosis, autism and dementia.

Source: ScienceDaily. Retrieved March 28, 2010 Howard Florey Institute (2006, December 13).
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Young men who report an unstable pattern of alcohol consumption including binge drinking have an elevated risk for experiencing hypomania, study results show. Notably, the effect was independent of total alcohol consumption and the presence of clinical alcohol use disorders.
“This fits with the idea that instability in different biological and behavioral systems is a core feature of risk for hypomania and finally risk for bipolar disorders,” say study authors Thomas Meyer (Newcastle University, UK) and Larissa Wolkenstein (University of Tübingen, Germany) in the journal Comprehensive Psychiatry.
Recent studies have suggested that vulnerability to hypomania is related to instability in certain psychologic processes. For example, individuals at risk for hypomania do not generally sleep less than others, but report a much more unstable sleeping pattern. Similarly fluctuations in self-esteem are much more characteristic of vulnerability to hypomania than are consistently low or high levels of self-esteem.
In the current study, the researchers assessed whether alcohol use might show a similar relationship to hypomania. They recruited 120 male students who completed the Hypomanic Personality Scale and were independently interviewed with the FORM 90 to assess alcohol consumption. The latter comprised an interview about a typical weekly drinking pattern and a calendar to assess drinking behavior over the last 90 days, noting special days with unusual drinking behavior.
The researchers found that intra-individual fluctuations in alcohol consumption predicted hypomania after accounting for clinical diagnoses of abuse or dependency. In addition, vulnerability for hypomania was significantly associated with mean standard ethanol content per drinking day.
Discussing their findings, the researchers note a recent theory that bipolar disorder is related to a hypersensitivity to reward-related cues, which is due to a dysregulation of the behavioral activation system.
“To extend this work further, it would be reasonable to look more closely at the motivational and affective processes associated with drinking alcohol and bipolar disorder and how mood and drinking are related,” Meyer and Wolkenstein comment.
Source: MedWire (www.medwire-news.md) 19 March 2010

Parents who try to teach responsible drinking by letting their teenagers have alcohol at home may be well intentioned, but they may also be wrong, according to a new study in the latest issue of the Journal of Studies on Alcohol and Drugs.

In a study of 428 Dutch families, researchers found that the more teenagers were allowed to drink at home, the more they drank outside of home as well. What’s more, teens who drank under their parents’ watch or on their own had an elevated risk of developing alcohol-related problems. Drinking problems included trouble with school work, missed school days and getting into fights with other people, among other issues.

The findings, say the researchers, put into question the advice of some experts who recommend that parents drink with their teenage children to teach them how to drink responsibly — with the aim of limiting their drinking outside of the home.

That advice is common in the Netherlands, where the study was conducted, but it is based more on experts’ reasoning than on scientific evidence, according to Dr. Haske van der Vorst, the lead researcher on the study.

“The idea is generally based on common sense,” says van der Vorst, of Radboud University Nijmegen in the Netherlands. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.”

But the current findings suggest that is not the case.

Based on this and earlier studies, van der Vorst says, “I would advise parents to prohibit their child from drinking, in any setting or on any occasion.”

The study included 428 families with two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.

The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home. In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.

The findings, according to van der Vorst, suggest that teen drinking begets more drinking — and, in some cases, alcohol problems — regardless of where and with whom they drink.

“If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence,” she says, “they should try to postpone the age at which their child starts drinking.”

Available at: http://www.jsad.com/jsad/link/71/105

Source: H. van der Vorst Journal of Studies on Alcohol and Drugs 71 (1), 105-114. Jan 2010

A LEADING medic at the Edinburgh Royal Infirmary today warned of the growing toll of Scots’ drinking habits as new figures showed liver disease deaths at the hospital have doubled in seven years.
The hospital, which is a referral centre for acute cases from across the whole of Scotland, had 67 fatalities from cirrhosis of the liver in 2005. A further 17 people died from the disease at the Western General Hospital in 2005 which, along with 2003, is the highest level for eight years.
Professor Peter Hayes today said there had been an “exponential rise” in cases among middle-aged men, in particular, in recent years which was showing no signs of slowing.
“The main problem is alcohol,” he said. “On the Continent, the problem seemed to peak in the 1970s and 1980s and cases have been falling since. They’re doing something very right, we’re doing something very wrong. I suspect it’s down to culture and the amount we consume.”
Prof Hayes, of the department of hepatology at the ERI, said more than half the cases were due to long-term alcohol abuse, typically people who have drunk a bottle of spirits a day for 20 years.
However, obese people and drug users who contracted hepatitis C by sharing needles in the 1970s and 1980s also account for a large proportion.
Prof Hayes warned that these health problems – although not as high as in some areas such as Paisley, near Glasgow – are growing in Edinburgh and Lothian.
“Deaths from liver disease in the UK, and Scotland in particular – and among middle-aged men in particular – are rising exponentially. Figures published in 2006 showed deaths in Scotland just massively increased, almost rising in a straight line.
“This is a national problem but one we are also seeing in Edinburgh and the Lothians.
“The problem is worse in Paisley, for example, but I’m sure it’s going up in Edinburgh, probably at the same rate just starting at a lower level.”
Some people are showing the signs of long-term alcohol abuse after just a few years of drinking, and there are also more female patients, but the most common sufferers continue to be men in their 50s and 60s.
Prof Hayes said: “We do see people in their 20s, they always catch your eye because they are so young, but the majority are older, and we still get more men than women.
“Alcohol is undoubtedly the most important reason for the rise. Hepatitis C is increasing – it takes a long time to cause sclerosis – but we are seeing a lot of people now who may have experimented with drugs, even just for a short time, 20 or 30 years ago.
“The third factor is obesity and diabetes. People are getting obese younger but living longer because of efforts to stop them dying from heart disease. This is putting pressure on their liver.”
Across Scotland 976 people died from liver disease in 2005, along with the same figure in 2003, the highest in eight years.
The figures, obtained by SNP MSP Christine Grahame, also showed that in 2005, 41,250 people were discharged from Scottish hospitals with an explicit diagnosis of an alcohol-related condition, 5441 in the Lothians.
She said the best way of turning the corner was by targeting the next generation of drinkers.
“We have to go back into schools with a determined education message,” she said.
“We think we’re immortal when we are young. When we do find young people with extreme difficulty with drinking we have to find residential places for them straight away.”

Source: Scotsman.com 27th Jan 2007

Research Summary

Researchers from Stanford University found that a *12-step oriented treatment program that included attending Alcoholics Anonymous meetings boosted two-year sobriety rates by 30 percent compared to cognitive-behavioral (CB) programs, the BBC reported Jan. 29.
Twelve-step oriented programs also cost 30 percent less than CB-based treatment for addiction, the researchers said.
Lead study author Keith Humphreys said the spiritual dimension of AA may explain why recovering alcoholics in such programs are better able to resist the temptation to return to drinking.
The study appears in the journal Alcoholism: Clinical and Experimental Research.
*Editor’s Note, Jan. 31, 2007:
As originally published on January 30, the title of the summary read: “AA Boosts Sobriety by 30 Percent, Study Says.” We have changed the title and summary to clarify that the researchers studied 12-step oriented treatment programs — not only AA meetings.

Source: Humphreys, K., Moos, R.H. (2007) Encouraging Posttreatment Self-Help Group Involvement to Reduce Demand for Continuing Care Services: Two-Year Clinical and Utilization Outcomes. Alcoholism: Clinical and Experimental Research, 31(1): 64–68; doi: 10.1111/j.1530-0277.2006.00273.x.

Recurrent drinking is common among patients with alcohol dependence who have received treatment. This study assessed whether certain types of relapses are more likely to recur, are more severe, or are more amenable to a particular psychosocial therapy.
Researchers examined data from 592 of 952 outpatients with alcohol dependence who had been randomized in a larger trial to receive motivational enhancement therapy, cognitive-behavioral therapy, or twelve-step facilitation therapy. These 592 subjects had experienced a relapse (i.e., drinking after being abstinent for at least 14 days) and completed the relapse-onset section of the Relapse Questionnaire, which assesses patient-perceived influences that contribute to relapse.
• Relapses were divided into 3 types: negative affect/family influences, craving/cued, and social pressure. When relapses recurred, they were often (about half the time) the same type as the initial relapse. Social pressure relapses were most likely to repeat (58% of the time). Negative affect relapses were the most severe (i.e., associated with a greater number of drinks consumed per day).
• The 3 therapies affected the overall risk of relapse similarly. However, motivational enhancement therapy offered less protection than the other therapies against social pressure relapse.
Comments:
This study provides a typology that can help clinicians efficiently assess relapse risk among patients with alcohol dependence. Clinicians who understand their patients’ prior types of relapses have the opportunity to provide individualized relapse prevention counseling or referral.
Peter Friedmann, MD, MPH

Source:Zywiak WH, Stout RL, Longabaugh R, et al. Relapse-onset factors in Project MATCH: the Relapse Questionnaire. J Subst Abuse Treat. 2006;31(4):341–345.

Brief skills training is effective to curb college drinking
A study in Swedish colleges, where over-use of alcohol is widespread, showed that a Brief Skills Training Program was effective in reducing alcohol consumption over a two-year period.

Students were randomly assigned to a brief skills training program (BSTP) with interactive lectures and discussions, a twelve-step–influenced (TSI) program with didactic lectures by therapists trained in the 12-step approach, and a control group. More than three quarters of the students were rated “high risk” on an alcohol consumption score.

At follow-up two years later, the high-risk students who had received the BSTP program showed significantly better outcomes than high-risk students who had undergone TSI. The TSI students did no better than the control group.

Source:The study results are in the March issue of Alcoholism: Clinical and Experimental

The brains of alcoholics can show measurable improvement in volume, chemical activity, and functionality after as little as seven weeks of abstinence, a new study published in the journal Brain today reveals.

Researchers from Germany, the UK, Switzerland and Italy collaborated on a study of ten men and five women alcoholics who had achieved an average of 38 days abstinence at the time of the study. Alcoholics who used psychoactive medications or who smoked more than 10 cigarettes a day after they stopped drinking were excluded from the data. Researchers used functional magnetic resonance imaging (fMRI) and proton MR spectroscopy, laboratory tests for levels of brain chemicals that measure nerve integrity and repair, and performance tests for attention and concentration.

Brain volume increased an average of two percent, researchers found, and there were major increases in the substances that measured nerve health and regrowth. There were also improvements in performance. However, in one subject, who had the longest history of alcoholism in the study (more than 25 years), the evidence of brain recovery was not visible within the relatively short time span of the study.

The leader of the research, Dr Andreas Bartsch from the University of Wuerzburg, Germany, said:
“The core message from this study is that, for alcoholics, abstinence pays off and enables the brain to regain some substance and to perform better. However, our research also provides evidence that the longer you drink excessively, the more you risk losing this capacity for regeneration. Therefore, alcoholics must not put off the time when they decide to seek help and stop drinking; the sooner they do it, the better.”

Source. Journal ‘Brain’ SUNDAY, DECEMBER 17, 2006

Strategies teenagers use to minimise alcohol-related harm
• Aims: To examine strategies of harm minimization employed by teenage drinkers.
• Findings: The teenagers participating in the present study were more concerned about social than health risks. The informants monitored their own level of intoxication, but in order to reduce alcohol consumption they depended upon support from their peers. The informants preferred drinking in the company of well-known and trusted peers, and during drinking episodes they supervised and intervened in each others’ drinking to the extent that they deemed it necessary and possible. In regulating the social context of drinking they relied on their personal experiences more than on formalized knowledge about alcohol and harm, which they had learned from prevention campaigns and educational programmes.
• Conclusions: The study found that teenagers may help each other to minimize alcohol-related harm, and teenage peer groups should thus be considered a resource for health promotion.
Morten Hulvej Jørgensen, Tine Curtis, Pia Haudrup Christensen, Morten Grønbæk (2007) Harm minimization among teenage drinkers: findings from an ethnographic study on teenage alcohol use in a rural Danish community

Source: Addiction 102 (4), 554–559

Viewing videotape of themselves while experiencing delirium tremens could reduce the relapse rate in alcohol-dependent patients
• The aim of this prospective randomized controlled study was to determine whether viewing videotape of themselves while experiencing delirium tremens (DT) reduces the relapse rate in alcohol-dependent patients.
• Findings: The patients with videotape experience had a significantly lower relapse rate after the first month (0% versus 20%), 2 months (13.33% versus 46.67%) and 3 months (26.67% versus 53.33%). Patients with videotape experience had less severe relapses and consumed fewer units of alcohol than controls.
• Conclusions: Videotape exposure in delirium tremens is an original therapeutic method which seems to be effective in reducing relapse risk in patients with alcohol dependence.
Adriana Mihai, Cristian Damsa, Michael Allen, Bertrand Baleydier, Coralie Lazignac, Andreas Heinz (2007) Viewing videotape of themselves while experiencing delirium tremens could reduce the relapse rate in alcohol-dependent patients

Source: Addiction 102 (2), 226–231.

* Popular and clinical lore support the strong connection between smoking and alcohol consumption.

* Adolescent smokers appear to have a greater vulnerability to developing alcohol-use disorders.

* Results indicate that smoking “primes” the brain for subsequent addiction to alcohol and possibly other drugs.

Both academic studies and casual observation support the view that smokers tend to drink, and drinkers tend to smoke. New research using nationally representative data from the U.S. finds that smokers – particularly adolescent smokers – clearly have a greater vulnerability to alcohol-use disorders (AUDs) than do non-smokers.

Results are published in the December issue of Alcoholism: Clinical & Experimental Research.

“Smoking and alcohol – separately, or together – account for more than 20 percent of deaths in the United States,” said Richard A. Grucza, an epidemiologist at Washington University School of Medicine and corresponding author for the study. “Cigarettes and alcohol are also known to be ‘gateway’ drugs, that is, the overwhelming majority of illegal drug users begin their use with one or both of these legal drugs.”

“We have known about the link between cigarette smoking and alcohol use for a while, but we have not really asked the question, as the authors here asked, whether use of one could increase the vulnerability of becoming addicted to the other,” said Kevin W Chen, associate professor at the University of Maryland School of Medicine.

“Ours was the first,” added Grucza, “to examine quantity of drinking in relationship to smoking and AUDs. Our central questions were: Can this association be explained by the fact that smokers are heavier drinkers, or is there something else going on? In other words, do smokers appear to be more sensitive to the effects of alcohol?” The short answer appears to be yes.

Researchers examined data from an aggregate of 2002 through 2004 U.S. National Surveys on Drug Use and Health. Randomly selected, household-dwelling adolescents and young adults (n=74,836) were selected from the non-institutionalized and civilian American population and queried about their drinking and smoking practices.

Results indicate that smokers – particularly adolescent smokers -have a greater vulnerability to AUDs than do non-smokers.

“In general, smokers were at more than a 50 percent higher risk, although the differences were larger in younger adolescents and among light drinkers,” said Grucza. “For example, among 15- to 17-year-olds who drank fewer than eight drinks in the month before the survey, more than 20 percent reported an AUD, compared with about five percent among the non-smoking group with the same level of drinking. We conclude that, although smokers do drink higher rates of alcohol, this alone does not explain their higher vulnerability to AUDs.”

Grucza said that these findings go beyond the popular view that bad behaviors like smoking and drinking to excess simply tend to “go together,” especially during adolescence. “It seems that smoking makes the adolescent brain more vulnerable to other addictions,” he said. “Addictive drugs all act on a part of the brain that is described as the ‘central reward circuitry.’” Once this system is exposed to one drug, the brain may become more sensitive to the effects of other drugs, as demonstrated by a number of rodent studies.

“Studies like this will set up an alert – for those who consider adolescent smoking tolerable – to rethink the issue, or perceive the problem differently,” noted Chen. “Although we do not know the exact causal relation between the two, the damage to our health is so severe that we need to create a more objective image to reject both smoking and drinking among adolescents.”

“Ours is the first study to – establish a correlation between adolescent smoking and AUDs that cannot be explained by heavier drinking,” said Grucza. “Now we, and hopefully others, need to investigate whether or not smoking actually causes adolescents to be more susceptible to AUDs. Our results are in line with an emerging literature that shows adolescence may be a unique window of vulnerability for addictions development. If it is proven that nicotine directly impacts vulnerability to alcoholism and other addictions, then that is a new, strong message to add to the health-education arsenal. However, even if this correlation is completely non-causal, these results can help to identify kids who are at risk for AUDs.”

Source:Alcoholism: Clinical & Experimental Research. (ACER) Article Date: 30 Nov 2006 – 13:00 PDT

Summary

Mobilized residents work with police, shopkeepers, bar owners to prevent alcohol-related problems in lower-income communities

When residents are actively involved in their neighborhoods, they can clean up the crime and violence. That’s according to a new study that found a significant decrease in assaults, car crashes and other alcohol-related crime with community participation. Calls to police and emergency medical services also dropped with this intervention program that addresses alcohol sales and service.

Researchers at the PIRE Prevention Research Center implemented and tested the program called the Sacramento Neighborhood Alcohol Prevention Project or SNAPP in an effort to reduce access to alcohol and the problems related in two low-income, predominantly ethnic minority neighborhoods. The intervention focused on individuals between the ages 15 and 29, an age group with high rates of alcohol-involved problems. Sacramento-based La Familia Counseling Center Inc. assisted in the project.

This article, published in the Journal of Studies on Alcohol and Drugs, highlights the results that show that changing the way alcohol is sold and served can reduce alcohol-related problems – even in high-crime neighborhoods. Researchers selected two economically and ethnically diverse neighborhoods in Sacramento that had high rates of crime and alcohol-related problems.

“These are neighborhoods that are most vulnerable to alcohol-related problems. Even these rather tough neighborhoods can take control of their own environments and reduce the negative effects of alcohol,” said study author, Andrew Treno, PhD.

The project includes five components: mobilization to support the project, community awareness, alcohol server training, underage drinking law enforcement and intoxicated patrons law enforcement. Along with members of community based organizations, the project researchers handed out informational pamphlets and held community meetings to raise awareness about alcohol-related problems. They organized neighborhood committees to mobilize residents. They also provided training at bars and stores selling alcohol to prevent selling alcohol to intoxicated patrons and to minors. Project members worked with local police to increase enforcement efforts of selling alcohol to minors and intoxicated persons. The researchers used these interrelated strategies to change the neighborhood environment with regard to the way alcohol is sold and served.

“Although we developed the overall study design, the communities provided valuable guidance into ways to reach the intervention goals and constituent groups,” Treno said. “For example, strategies for scheduling police stings were worked out based on the needs of the project’s and available police resources. At committee meetings, community members agreed to address alcohol-related issues along with law enforcement and other local authorities. They all worked together for the betterment of their neighborhoods.”

Previous research has shown that if localities change their alcohol environment by more strictly controlling where and how and to whom alcohol is served and sold, alcohol-related problems such as drunken driving can be reduced. The study was intended to show that this type of change in the alcohol environment could work even in difficult settings. Reductions in calls for emergency medical services and police reports of assaults were found in the neighborhoods that participated in the program. Similar reductions were found for illegal sales to minors.

Following the implementation of these strategies, there was a significant reduction in the number of assaults reported by police and a reduction in calls for emergency medical services resulting from assaults and motor vehicle crashes. There was also a significant reduction in sales of alcohol to people who appeared to be minors. No significant changes were found in service of alcohol to patrons who appeared to be intoxicated. Researchers compared these outcomes to the situation prior to the program and to comparison neighborhoods in Sacramento that did not receive the program.

Source: www.pire.org March 2007

The number of people admitted to hospital in England with alcoholic liver disease has more than doubled in just 13 years, figures show.
Between 1989 and 2003 admissions for the disease increased by 116% in men and 108% in women.
The figures, from London’s St George’s Hospital and the Office for National Statistics, were presented at a British Society of Gastroenterology meeting.
They underline just how much of a drain alcohol abuse is on NHS resources.

The figures show that there was a rise in admissions in people of all ages – including young adults.
In the year 2002/03, the admission rate for alcoholic liver disease was 42.4 per 100,000 men, and 27.6 per 100,000 women.
Many health campaigners have voiced concern that changes to licensing laws, allowing more pubs and clubs to stay open for longer, could lead to increases in alcohol-related illness and public disorder in the UK.
Lead researcher Dr Mark Fullard said that with hospitals already struggling to cope with demand, the rising number of cases of alcoholic liver damage was a potentially huge problem.
“The research findings highlight an important problem in public education and health planning and how we are going to manage alcohol related problems in this country.
“If it doubles again, it is going to have tremendous implications for the future burden of care in hospitals.”

The actual number of women admitted with alcoholic liver problems is about half that of men – but the rate of increase in cases is similar.
The diseases included in the study range from mild alcoholic hepatitis – mild inflammation of the liver – through to very severe cirrhosis and liver cancer.
Dr Fullard said: “If you are young and have alcoholic liver disease and carry on drinking, then you will get severe alcoholic liver disease.”
Dr Elwyn Elias, of the British Society of Gastroenterology, said: “It is very important that we are flagging this up at a time when the consumption of alcohol in this country is continuing to increase.
“I think we are unmasking an iceberg effect where we are storing up enormous problems for the NHS in the future.”

Source: BBC News Reported in Daily Dose 15th March 2005

A steady rise in long-term heavy drinking has led to a doubling of alcohol-related deaths among men over the past decade, according to official figures.
The study of “preventable mortality” found that the rate of alcohol-related deaths had risen sharply among women too, with two thirds more dying of diseases such as cirrhosis over the period.
The rise in alcohol-related deaths is in stark contrast to sharp falls in the rest of the top five “preventable causes of mortality”.
Lung cancer and other pulmonary diseases are both down by a third, while suicide is down by 14 per cent. The data were released in the Office for National Statistics’ quarterly survey of the nation’s health.
Alcohol Concern said that the biggest increase in alcohol-related deaths was among those aged 35 to 54, a generation of people who started drinking heavily in their youth and carried on into middle age.

Source: From The Times Online May 25, 2007

Research Summary

A study of U.S. Marine Corps recruits conducted in San Diego adds further weight to previous findings that early-age drinking increases the risk of problem drinking later, MedPage Today reported Dec. 5.
The study looked at 41,482 male recruits and found that those who had begun drinking at age 13 or earlier were 5.5 times more likely to be engaging in risky drinking. Other factors associated with risky drinking included engaging in smoking, coming from a rural or small-town community, enduring childhood sexual or emotional abuse, and experiencing alcohol abuse or mental illness in the household.
Researchers led by Margaret Ryan, M.D., M.P.H., of the Naval Health Research Center, used three alcohol consumption questions on the Alcohol Use Disorders Identification Tests (AUDIT-C) to measure risky drinking. A total of 14.8% of the recruits were categorized as risky drinkers; 45.1% were non-risky drinkers and 40.2% were non-drinkers.
Some factors that were inversely associated with risky drinking in the study included being married and attending religious services at least weekly.
The researchers concluded that the study results reinforce the need for public health efforts to prevent tobacco use and child abuse. An important question to be answered is whether reducing youth smoking would also reduce risky drinking, they said.

Source: Archives of Pediatrics and Adolescent Medicine. Dec. 2006

Thursday 1 June 2006

UK adults and adolescents are among the top binge-drinkers in Europe, according to the first-ever comprehensive EU-wide report on alcohol released this Thursday.
The report, funded by the European Commission and written by the UK-based Institute of Alcohol Studies, shows that:
• The UK are one of the top bingeing nations in western Europe, binge-drinking 28 times per year on average – about once every 13 days.
• UK adolescents are also the third-worst binge-drinkers in the EU, with more than a quarter 15-16 olds binge-drinking 3-or-more times in the last month.
Yet the main message of the report – commissioned to provide the evidence base for the EU’s alcohol strategy due later this year – is the scale of alcohol-related harm across the EU:
• Alcohol is public health enemy #3, behind only tobacco and high blood pressure, and ahead of obesity, lack of exercise or illicit drugs.
• Many people suffer due to someone else’s’ drinking – including 5-9 million children living in families damaged by alcohol and the 10,000 ‘innocent’ deaths that occur to bystanders or passengers from drink-drivers.
• Alcohol is also estimated to cost Europe €125 billion – equivalent to over €650 for every household each year.
The report concludes with a series of 52 recommendations in areas ranging as widely from taxation to education to research, setting out the areas that the scientific evidence suggests the Commission should act on in its forthcoming strategy.
- Professor Christine Godfrey, Professor of Health Economics at the Centre for Health Economics at the University of York, said:
“This is the best estimate yet conducted showing the scale of the social costs of alcohol in Europe. But more importantly, the report shows that cost-effective polices are available, and that predictions of catastrophic job losses for implementing effective policies are much overstated.”
- Dr Anderson, lead author of the report and international public health expert, said:
“What really makes the need for action so urgent is that we know ‘what works’ in reducing this toll. What we now need is just to get on with it.”

Source: Institute of Alcohol Studies June 2006

Young men are three times more likely to die from alcohol-related injuries than females. To make matters worse, new research released today shows that they do not respond to school-based drug education as well as their female counterparts.
Delivery of a new school-based program has resulted in lower alcohol consumption, less binge drinking and less alcohol-related harms – but only in females.
CLIMATE Schools: Alcohol Module was developed and trialled by the National Drug and Alcohol Research Centre (NDARC) at the University of NSW. Researcher, Ms Laura Vogl, found that the findings were consistent with the results of many other school-based drug prevention programs.
“Males are a much harder group to reach,” Ms Vogl said. “It is common knowledge that alcohol use generally increases from the early to late teenage years. This program was effective in subduing this growth. Twelve months after the program was delivered it was clear that the CLIMATE program had subdued the growth of alcohol use and harm for females.”
After one year, students who did not get the CLIMATE program reported:
o Twice the increase in average weekly alcohol consumption compared with the students who received the CLIMATE program.
o A fives times greater increase in the frequency of binge drinking compared with the students who received the CLIMATE program.
o Twice the increase in the maximum number of drinks consumed during these binging occasions, and
o A five times greater increase in the number of alcohol-related harms experienced in the previous 12 months compared with the students who received the CLIMATE program

CLIMATE Schools: Alcohol Module was developed by NDARC in collaboration with the Clinical Research Unit for Anxiety and Depression and secondary school teachers. This program was trialled with over 1,500 Year 8 students in Catholic and Independent schools. This innovative program uses a computerised cartoon-based teenage drama to teach young people skills to minimise alcohol consumption and reduce the risk of harm.
The program was successful in teaching all young people, both males and females, the knowledge to minimise alcohol-related harm. It was also effective in moderating students’

beliefs regarding the positive benefits of alcohol. Students were far less likely to glamorise the effects of alcohol after they had completed the CLIMATE program.
However, when it came to behaviour change, it was only female students who changed their behaviour.
For the boys, the CLIMATE program was no more effective in changing alcohol use behaviour than the standard alcohol prevention education currently being delivered in the control schools.
Ms Vogl said that there could be a number of reasons to explain this result.
”The Australian Alcohol Guidelines were used in the program and these state that males can drink more alcohol than females to stay at low risk,” explained Ms Vogl. ”Currently, many young females drink similar amounts to their male counterparts. Pointing out to young women that they cannot actually drink as much alcohol for the same level of risk, may have been a shock for many and made them rethink their behaviour.“
Drinking and the experience of alcohol-related harm is often seen as a badge of honour or sign of manhood and could be a contributing factor to the gender differences.
“If a male student is involved in a fight, he may be viewed as a hero. Likewise, if a male has unplanned sex whilst under the influence of alcohol, he may be viewed as a stud. By contrast, if a female accidentally falls pregnant while under the influence of alcohol, she may be viewed as promiscuous. If she vomits in a public place as a result of drinking, the consequences can be dire.”
Traditionally, male socialisation and friendships also revolve more closely around alcohol than that of females. For alcohol prevention interventions to be effective with male students a broader range of alcohol related beliefs may need to be targeted.
Research has suggested that it may be necessary to focus on the negative sexual effects of alcohol, such as erectile dysfunction, to achieve success. The only obstacle to this is that it may be considered inappropriate to teach this in Year 7 and 8 of high school, when alcohol prevention education needs to be implemented.
“Alcohol-related harm is a major concern during adolescence, especially for males. Effective alcohol prevention programs do exist and in many cases are the ones implemented in schools. However, greater time needs to be given for more intensive interventions with the hope of more effectively changing the behaviour of young males.”
ends

Source: NDARC. Univ. of New South Wales. Australia February 25 2007

Analysis of a national sample of individuals with alcohol dependence (alcoholism) revealed five distinct subtypes of the disease. This finding should help dispel the myth that alcoholism is easily categorized and that an individual can be classified as a ‘typical alcoholic’.
Scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH) report their finding in the journal Drug and Alcohol Dependence.
“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” notes first author Howard B. Moss, M.D., NIAAA Associate Director for Clinical and Translational Research.
“We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes.
“More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes.”
“Clinicians have long recognized diverse manifestations of alcoholism,” adds NIAAA Director Ting-Kai Li, M.D, “and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not. The classification system described in this study will have broad application in both clinical and research settings.”
Previous efforts to identify alcoholism subtypes focused primarily on individuals who were hospitalized or otherwise receiving treatment for their alcoholism.
However, recent reports from NIAAA’s National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a nationally representative epidemiological study of alcohol, drug, and mental disorders in the United States, suggest that only about one-fourth of individuals with alcoholism have ever received treatment.
Thus, a substantial proportion of people with alcoholism were not represented in the samples previously used to define subtypes of this disease.
In the current study, Dr. Moss and colleagues applied advanced statistical methods to data from the NESARC. Their analyses focused on the 1,484 NESARC survey respondents who met diagnostic criteria for alcohol dependence, and included individuals in treatment as well as those not seeking treatment.
The researchers identified unique subtypes of alcoholism based on respondents’ family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional substance abuse and mental disorders:
Young Adult subtype: 31.5 percent of U.S. alcoholics. Young adult drinkers, with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, and who rarely seek any kind of help for their drinking.
Young Antisocial subtype: 21 percent of U.S. alcoholics. Tend to be in their mid-twenties, had early onset of regular drinking, and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder, and anxiety problems. More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one-third of these alcoholics seek help for their drinking.
Functional subtype: 19.5 percent of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.
Intermediate Familial subtype: 19 percent of U.S. alcoholics. Middle-aged, with about 50 percent from families with multigenerational alcoholism. Almost half have had clinical depression, and 20 percent have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent ever sought treatment for their problem drinking.
Chronic Severe subtype: 9 percent of U.S. alcoholics. Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine, and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.
The authors also report that co-occurring psychiatric and other substance abuse problems are associated with severity of alcoholism and entering into treatment. Attending Alcoholics Anonymous and other 12-step programs is the most common form of help-seeking for drinking problems, but help-seeking remains relatively rare.

Source: National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism June 2007

The report, published online in the International Journal of Cancer, found that people who drink 15 grams of alcohol a day – equivalent to about two units – have about a 10 per cent increased risk of bowel cancer.
Those who drank more than 30 grams of alcohol – equivalent to three to four units which is less than a couple of pints of strong lager – increased their bowel cancer risk by around 25 per cent.

Source: Internatinal Journal of Cancer July 2007

Alcohol related hospital admissions double in last ten years according to latest official figures
The latest compendium of figures issued today (26 June) by the independent provider of official health and social care statistics, the Information Centre (The IC) show how hospital admissions specifically related to alcohol consumption have more than doubled in the last ten years.
In 2005/06, there were 187,640 NHS hospital admissions among adults aged 16 and over with either a primary or secondary diagnosis specifically related to alcohol. This has increased from 89,280 in 1995/96.
In its alcohol statistics bulletin, the most comprehensive and up to date compendium of facts and figures about alcohol consumption in England, The IC also found that:
• Among children under 16 there were 5,280 NHS Hospital admissions in 2005/06 with either a primary or secondary diagnosis specifically related to alcohol. This represents an overall increase of just over a third from 3,870 in 1995/96.
• In 2005, 6,570 people died from causes directly linked to alcohol consumption, of these just under two thirds (4,160) died from alcoholic liver disease. Two thirds (67 per cent) of those dying from alcoholic liver disease were men.
• In England in 2005, 73 per cent of men and 58 per cent of women reported drinking an alcoholic drink on at least one day in the week prior to interview. Thirteen per cent of men and 8 per cent of women reported drinking on every day in the previous week.
• Thirty-four per cent of men and 20 per cent of women had drunk more than the recommended number of units on at least one day in the week prior to interview. Eighteen per cent of men and 8 per cent of women had drunk more than twice the recommended daily intake.
• Older people were more likely to drink regularly – 28 per cent of men and 18 per cent of women aged 45-64 drank on five or more days in the week prior to interview compared to 10 per cent of men and 5 per cent of women aged 16-24. Younger people were more likely to drink heavily, with 42 per cent of men and 36 per cent of women aged 16-24 drinking above the daily recommendations compared to 16 per cent of men and 4 per cent of women aged 65 and over.
• Among men, 24 per cent reported drinking on average more than 21 units in a week. For women, 13 per cent reported drinking more than 14 units in an average week.
The bulletin also looked at awareness of the Government’s alcohol warnings and found that whilst 69 per cent of people reported that they had heard of the government guidelines on alcohol consumption, of these people, more than a third said that they did not know what the recommendations were. Thirty two per cent of adults however had seen units of alcohol displayed on labels of alcoholic drinks, compared to 23 per cent in 2000.
In England in 2005, 45 per cent of pregnant women did not drink at all during pregnancy, while 39 per cent reported drinking on average less than 1 unit a week and only 8 per cent drank 1 to 2 units Alcohol is more affordable than ever according to the figures.
In 2006, alcohol was 65 per cent more affordable than it was in 1980. Household expenditure on alcohol has increased steadily since 1980 as has total household expenditure; however expenditure on alcohol as a proportion of total household expenditure has decreased steadily over the same period standing at 5.2 per cent in 2006 compared to 7.5 per cent in 1980. In 2004, the Government estimated that alcohol misuse costs the health service between £1.4 and £1.7 billion per year.
Commenting on the figures, Professor Denise Lievesley, Chief Executive of The Information Centre, says:
“These figures show some worrying trends about the effects on society of consuming excessive amounts of alcohol. The doubling of alcohol related hospital admissions and increases in serious illness and death caused by alcohol gives cause for concern. We hope Government and other policy makers will use these figures to inform the development and implementation of policies to help reduce the harm that excessive alcohol consumption can cause.”

Source:: pubs/alcoholeng07 June 2007

November 9, 2006

Men diagnosed with cancer are less likely to survive the disease if they were smokers or heavy drinkers. Smoking and drinking are well-known risk factors for cancer, but researchers have begun looking into how these addictions affect survivability, as well. Researcher Young Ho Yun and colleagues at the National Cancer Center in Goyang, South Korea tracked 14,578 cancer patients for about nine years and compared mortality data to patients’ history of smoking and alcohol use.
The researchers found that former smokers were more likely to die from any kind of cancer than nonsmoking cancer patients, possibly because smoking causes tumors to grow more aggressively. Smokers also may be less likely to get cancer screening tests, the authors noted, so their disease is often further advanced when treatment begins.
Among patients with head, neck, or liver cancer, heavy drinkers were more likely to die than nondrinkers, with risk increasing with consumption levels.
“Our findings suggest that groups at high risk of cancer need to be educated continually to improve their health behaviors — not only to prevent cancer, but also to improve prognosis,” the study authors noted.

Source: Journal of Clinical Oncology Nov. 1, 2006.

Reference:
Park, S.M., Lim, M.K., Shin, S.A., Yun, Y.H. (2006) Impact of Prediagnosis Smoking, Alcohol, Obesity, and Insulin Resistance on Survival in Male Cancer Patients: National Health Insurance Corporation Study. Journal of Clinical Oncology, 24(31): 5017-5024.

Research Summary

Vitamin K helps prevent brain injury in newborns. If alcohol dependence is associated with brain development in infancy, giving babies vitamin K might reduce their future risk of dependence. To explore this possibility, researchers studied a 30-year prospective cohort of male infants in Denmark.
Of 238 men, 18% had received 1 mg of vitamin K intramuscularly at birth, 16% had alcohol dependence (assessed at age 30), and 68% had fathers with alcohol dependence. Receipt of vitamin K was not significantly associated with gestational age, birth weight, birth complications, or signs of neurological impairment at birth.
• Only 5% of men who had received vitamin K at birth had alcohol dependence compared with 18% of men who had not received the vitamin.
• In an analysis adjusted for birth weight and having a father with alcohol dependence, men who had received vitamin K had significantly fewer symptoms of alcohol dependence.
Comments by Richard Saitz, MD, MPH:
The results of this analysis suggest that perinatal brain injury (e.g., hemorrhage, which is now much less common due to universal administration of vitamin K to neonates) increases the risk of alcohol dependence. These results also imply that preventive interventions that reduce neurological trauma early in life may lower vulnerability to dependence later.
Reprinted with permission from Alcohol and Health: Current Evidence.

Source: JoinTogether Online. Jan.2006

Alcohol-related deaths in England and Wales are twice as high among people born in Scotland or Ireland compared with the rest of the population, a study has shown
Alcohol-related deaths in England and Wales are twice as high among people born in Scotland or Ireland compared with the rest of the population, a study has shown.
Research, conducted by the University of Edinburgh and the Office for National Statistics, also found that men born in India – but living in England and Wales – had similar rates of alcohol-related death as Scottish- and Irish-born people.
The findings showed too that people born in parts of Asia or Africa were at greater risk of dying from liver cancer, but generally had lower rates of alcohol-related deaths. The higher rate of death from liver cancer could be attributable to the fact that viral hepatitis is more common in ethnic minority communities.
The team used information on deaths for England and Wales from 1999 to 2003 and figures from the 2001 census to quantify the link between a person’s country of birth and the likelihood of dying from an alcohol-related condition.
The difference in alcohol-related deaths rates could be explained by cultural differences in rates of alcohol consumption. For example, adults who are Scottish or Irish have been shown on average to drink more than the recommended limit of alcohol.
The study, published in the Journal of Public Health, follows recent reports that alcohol-related hospital admissions in the over 65s are rising.
Dr Neeraj Bhala, who led the study, said: “Deaths from alcohol-related conditions, liver disease and liver cancer are increasing in the UK, but little is known about the role of ethnicity or country of birth. Some ethnic groups appear to be setting an example for the population as a whole with very low rates of liver disease, almost certainly as a result of low alcohol consumption.”
“These findings show significant differences in death rates by country of birth for both alcohol-related deaths and liver cancer. We now need to focus on developing new policy, research and practical action to help address these differences.”
Alcohol is thought to cause as much death and disability worldwide as tobacco use or high blood pressure. In England alone, alcohol misuse is estimated to costs more than £20 billion a year.

Source: EurekaAlert. 19th March 2009

Brain volume decreases with age at an estimated rate of 1.9 percent per decade, accompanied by an increase in white matter lesions, according to background information in the article. Lower brain volumes and larger white matter lesions also occur with the progression of dementia and problems with thinking, learning and memory. Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease; because the brain receives blood from this system, researchers have hypothesized that small amounts of alcohol may also attenuate age-related declines in brain volume.
Carol Ann Paul, M.S., of Wellesley College, Mass., and colleagues studied 1,839 adults (average age 60) who were part of the Framingham Offspring Study, which began in 1971 and includes children of the original Framingham Heart Study participants and their spouses. Between 1999 and 2001, participants underwent magnetic resonance imaging (MRI) and a health examination. They reported the number of alcoholic drinks they consumed per week, along with their age, sex, education, height, body mass index and Framingham Stroke Risk Profile (which calculates stroke risk based on age, sex, blood pressure and other factors).
“Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers,” the authors write. “There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume.”
Although men were more likely to drink alcohol, the association between drinking and brain volume was stronger in women, they note. This could be due to biological factors, including women’s smaller size and greater susceptibility to alcohol’s effects.
“The public health effect of this study gives a clear message about the possible dangers of drinking alcohol,” the authors write. “Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption. This study suggests that, unlike the associations with cardiovascular disease, alcohol consumption does not have any protective effect on brain volume.”

Source: Paul et al. Association of Alcohol Consumption With Brain Volume in the Framingham Study. Archives of Neurology, 2008; 65 (10): 1363 DOI:

Key findings from Professor Martin Plant, Alcohol Health and Research Unit,Faculty of Health and Sciences, University of the West of England and AlcoholConcern, the national agency on alcohol misuse.

Professor Plant and his team were commissioned by Alcohol Concern in April 2009 to investigate what the future may hold for the nation’s drinking habits and associated harms. Professor Plant’s forecasting allows us to answer how our drinking patterns are likely to affect the state of the nation’s health in 2035.

For the first time in the UK, the relationship between alcohol consumption and mortality has been calculated. The research indicates a definitive link: the higher our society’s alcohol consumption, the more deaths occur as a result. Based on this, it is possible to forecast how health harms from alcohol may increase in the next 10 years if we continue to drink at the rate of the last 15 years.

Source: www.Alcoholconcern.org.uk Oct 2009

A new Australian study suggests that parental encouragement leads to alcoholism in teenagers. The latest MBF Healthwatch survey found that 63percent of Aussies in the higher income bracket approve of alcohol consumption by 15 to 17 year olds at home under the eyes of parents.
“Our survey suggests many Australians believe it’s acceptable to buy alcohol for teenagers and allow them to drink under parental supervision at home,” Bupa Australia Chief Medical Officer, Dr Christine Bennett, said.
Dr Bennett continued: “Some parents may think this is harmless; some may see this approach as a way to teach their teenage children about socially responsible drinking. But we want parents to understand that early exposure may actually be doing them damage. “Evidence suggests that the earlier the age that alcohol is introduced, the greater the risk of long-term alcohol related health problems.
“Binge drinking in young people is on the rise. Too much alcohol impairs young people’s judgement, which can lead to violence, injury and build a pattern of use that leads to lifetime dependence. “It’s shocking to think that one teenager a week dies of alcohol abuse. We teach children about the harmful effects of smoking, unsafe sex and taking illicit drugs, but we also need to teach them about the damage that alcohol can do.”
The survey also found that people’s acceptance of supervised underage drinking was closely related to their income levels. Nearly 63percent people earning over 100,000 dollars approved supervised drinking; 53percent people with incomes between 70,001 to 100,000 dollars were comfortable with the idea followed by 48percent people getting paychecks ranging from 40,001 to 70,000 dollars.
Dr Bennett added: “Given that social drinking is a common part of the Australian culture, our challenge is to help our young people learn how to enjoy alcohol in a socially responsible way and protect them from harm now and in the long-term.
“That will mean educating young people about the risks of underage drinking and, as parents and a community, being good role models.”

Source: Health News Dec. 3rd 2009

Children, whose parents allow them to have alcohol at home in a bid to teach responsible drinking, drink even more outside of home, a new study claims.
A study of 428 Dutch families has found that teens who drank under their parents’ watch or on their own were at a greater risk of developing alcohol-related problems. The researchers insists that the study puts into question the advice of some experts who recommend that parents drink with their teenage children with the aim of limiting their drinking outside of the home.
Dr. Haske van der Vorst, the lead researcher on the study, said: “The idea is generally based on common sense. For example, the thinking is that if parents show good behavior-here, modest drinking-then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.” Every family, which was quizzed, had two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.
The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home.
In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.
Haske van der Vorst, of Radboud University Nijmegen in the Netherlands concluded: “I would advise parents to prohibit their child from drinking, in any setting or on any occasion. “If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence, they should try to postpone the age at which their child starts drinking.” (ANI)

Source: Health News. Jan 28th 2010

Alcohol-related death rates by sex, United Kingdom, 1991-2008

The number of alcohol-related deaths in the United Kingdom has consistently increased since the early 1990s, rising from the lowest figure of 4,023 (6.7 per 100,000) in 1992 to the highest of 9,031 (13.6 per 100,000) in 2008. Although figures in recent years suggested that the trend was levelling out, alcohol-related deaths in males increased further in 2008. Female rates have remained stable.

There are more alcohol-related deaths in men than in women. The rate of male deaths has more than doubled over the period from 9.1 per 100,000 in 1991 to 18.7 per 100,000 in 2008. There have been steadier increases in female rates, rising from 5.0 per 100,000 in 1991 to 8.7 in 2008, less than half the rate for males. In 2008, males accounted for approximately two-thirds of the total number of alcohol-related deaths. There were 5,999 deaths in men and 3,032 in women.

Source: Office of National Statistics 29th January 2010

Oct 8, 2007 in alcohol, hospital
Tags: risky drinking, teenage binge drinking
The Telegraph:
One in seven people taken to hospital for drinking too much in the past year was under 14 years old, according to new figures.
A total of 2,239 under-14s were given treatment in A&E suffering from the effects of alcohol over the past 12 months, a study found – one in seven of the total under 59 admitted.
The revelations about the scale of underage drinking led to renewed calls for a clampdown on alcohol advertising seemingly targeted at children.
The last time The Telegraph looked at this issue (February 2007) they found there were 7,596 admissions involving 16- to 19-year-olds. The Guardian in June this year were reporting “that last year 5,280 children younger than 16 were admitted because of their drinking – of whom 59% were girls”. Previously (November 2006) the BBC had said they had found out there were “20 cases a day of under-18s diagnosed with conditions like alcohol poisoning.”

Source: Daily Dose 13th Oct.2007

For the first time, federal researchers have broken down the disease of alcoholism into five distinct subtypes, which experts say should help provide more targeted treatment for problem drinkers.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported June 28 that the five new subtypes include “Young Adult,” “Young Antisocial,” “Functional,” “Intermediate Familial,” and “Chronic Severe.”
“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” said study lead author Howard B. Moss, M.D., associate director of NIAAA’s Clinical and Translational Research division. “We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes. More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes.”
“Clinicians have long recognized diverse manifestations of alcoholism, and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not,” added NIAAA Director Ting-Kai Li, M.D. “The classification system described in this study will have broad application in both clinical and research settings.”
Moss and colleagues developed their subtypes based on survey respondents’ family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional addictive and mental disorders.
They found that 31.5 percent of alcoholics in the U.S. fall under the Young Adult subtype, who have relatively low rates of other drug or mental-health problems, low rates of family alcoholism, and rarely seek help for their drinking. The Young Antisocial subtype accounts for 21 percent of alcoholics, the researchers said; this category includes drinkers in their mid-20s who tend to have early onset of drinking, a family history of alcoholism, mental-health problems, and co-occurring tobacco or illicit-drug use. This group was more likely to have sought help for drinking than the Young Adult subtype.
Members of the Functional subtype, accounting for 19.5 percent of alcoholics, are typically middle-aged and well-educated, with stable jobs and families. They are relatively likely to have a family history of alcoholism and a personal history of major depressive illness in their lives, and about half are smokers. A similar percentage (19 percent) of American alcoholics fall into the Intermediate subtype, who are middle-aged and more likely to have a family history of alcoholism and mental illness than the Functional subtype. Most are smokers, problems with other drug use is relatively common, and about a quarter have sought help for their drinking.
The final subtype identified by Moss and colleagues, Chronic Severe, covers 9 percent of alcoholics. Most are middle-aged, with early onset drinking, high rates of antisocial personality disorders and criminality, and a strong family history of alcoholism. This subtype is typified by the highest rates of mental-health problems, smoking, and illicit-drug use, and two-thirds of this group has sought treatment for their drinking problems
Source: Drug and Alcohol Dependence. June 2007

For Immediate Release – January 5, 2010 – (Toronto) – A recent evaluation by the Centre for Addiction and Mental Health (CAMH) shows that online interventions for problem alcohol use can be effective in changing drinking behaviours and offers a significant public health benefit.
In the first evaluation of its kind, the study published in Addiction found that problem drinkers provided access to the online screener www.CheckYourDrinking.net, reduced their alcohol consumption by 30% — or six to seven drinks weekly – rates that are comparable to face-to-face interventions. This result was sustained in both the three and six month follow-up.
Source: www.camh.net 5 Jan.2010

A new study from Perth’s Telethon Institute for Child Health Research has found evidence that the amount and timing of alcohol consumption in pregnancy affects child behaviour in different ways.

The study has just been published online in the international journal Addiction.
Lead author Colleen O’Leary said the analysis was drawn from a random sample of more than 2000 mothers who completed a questionnaire three months after the baby’s delivery, and were then followed up when the child was 2, 5 and 8 years of age.

“Mothers who reported what we would classify as heavy drinking in the first trimester of pregnancy were nearly three times as likely to report that their child suffered with anxiety and/or depression or somatic complaints,” Ms O’Leary said. “Those who drank moderately during that first trimester were twice as likely to report those types of behavioural issues for their child.

“Exposure to moderate or heavy levels of alcohol in late pregnancy increased the risk of aggressive types of behaviours in the child.“This research suggests that both the timing and the intensity of alcohol exposure in the womb affect the type of behaviour problems expressed.”In this study low levels of alcohol did not increase the risk of harm to the baby. However, the evidence clearly shows that the risk to the baby increases with increasing amounts consumed.

“It should also be noted that in this study moderate exposure is classified as drinking 3-4 standard drinks per occasion- that’s about two normal glasses of wine-and no more than a bottle of wine drunk over a week.” Heavy drinking included women who were drinking the equivalent of more than a bottle of wine per week. It is important that women who had consumed alcohol while pregnant are not panicked by the findings.

“Not every smoker gets lung cancer despite them being at higher risk – and in this case, not every child will be affected by prenatal exposure to alcohol. However it is important that women have this information about increased risk so that they can make informed decisions to give their child the best start to life,” Ms O’Leary said.

The National Health and Medical Research Council recommend that the safest choice for women who are pregnant or planning a pregnancy is to abstain from alcohol.
Ms O’Leary said health professionals can assist by talking to women of child bearing age about their alcohol consumption and encouraging pregnant women and women planning a pregnancy to abstain from alcohol.
Source: O’Leary et al. Evidence of a complex association between dose, pattern and timing of prenatal alcohol exposure and child behaviour problems. Addiction, November 2009

By LINDSAY McINTOSH

THE antisocial effects of underage drinking are felt by communities across Scotland, with some areas becoming no-go zones on Friday and Saturday nights as a result.
But the real cost of the country’s child drink shame is human, with some youngsters killing themselves with booze.

Just over a year ago, the body of schoolgirl Naomi Thomson was found at a friend’s house in Fraserburgh, Aberdeenshire.
Her death certificate says the fatality is “unexplained”, but it lists “probable acute alcohol intoxication”. It is believed the 14-year-old drank herself to death at a sleepover party.

In February 2002, Craig Ritchie, 13, died after taking part in a secret drinking session with friends. He choked on his own vomit and suffered a heart attack. He was admitted to hospital in a coma and was declared dead ten days later. The pupil at Aberdeen’s Kincorth Academy had been drinking cider with a group of friends in Cove on the city’s outskirts.

In December 2005, two 13-year-old girls were found drunk and unconscious on a snow-covered street after going to an under-18s disco. One was on the brink of death when police officers discovered the scantily clad girls in Westhill, Aberdeenshire. The teenager did not come round for six hours after being treated for hypothermia and alcohol intoxication at Aberdeen Royal Infirmary.

Earlier this month, two girls of the same age were found on the streets in “mortal danger”, according to police. The pair had handed over their pocket money to a man to buy them alcohol from an off- licence in Livingston. Police said they could have lost their way and fallen unconscious which, combined with the cold weather, might have had fatal consequences. During an eight-hour blitz on the town, officers found six “heavily drunk” youths and took them to the police station to sober them up.

The definition of “under-age” sank to a shocking low this October, when community wardens in Cowie, Stirlingshire, caught a boy of seven swigging from a bottle of strong cider. Alcohol campaigners said the youngster could have died if he had drunk the whole one-litre bottle.

Wardens said they found young people openly drinking in the village streets, in flagrant disregard of local by-laws.

Jack Law, chief executive of the Alcohol Focus Scotland charity, said at the time: “Under-age drinking is a massive problem in Scotland, but we are obviously shocked at the age of this child. “There is evidence children find it relatively easy to access alcohol from adults. But these people need to realise there could be serious consequences.”

Under-age drinking is not only a pastime of children from deprived backgrounds. In the summer of 2000, Euan Blair, 16-year-old son of then-prime minister Tony Blair, was held for being drunk and incapable in Trafalgar Square. An ambulance was called for the teenager, as police were worried about his condition. He had been vomiting but did not require hospital treatment. The youngster had been at a post-exam celebration and gave a false name and address to police but was released without charge.
Source: The Scotsman 27 December 2007

Center for Bioinformatics, National Laboratory of Protein Engineering and Plant Genetic Engineering, College of Life Sciences, Peking University, Beijing, People’s Republic ofChinaThe research reveals that a subject’s brain with low beta-endorphin levels becomes accustomed to the presence of an exogenous surplus, diminishing its own supply and triggering dependence on an external source–in this case, alcohol.
According to a study by the research group “Alcoholism and drug addiction”, of the University of Granada, although there are no specific reasons to become alcoholic, many social, family, environmental, and genetic factors may contribute to its development. Thanks to this study, researchers have shown that the lack of endorphin is hereditary, and thus that there is a genetic predisposition to become addicted to alcohol. Beta-endorphin is a kind of “morphine” released by the brain in response to several situations, such as pain. In this way, beta-endorphins can be considered “endogenous analgesics” to numb or dull pains.
Researchers have focused on the low beta-endorphin levels in chronic alcohol abusers. According to José Rico Irles , professor of Medicine of the UGR, and head of the research group, this low beta-endorphin level determines whether someone may become an alcoholic. When a subjects’ brain with low beta-endorphin levels gets used to the presence of an exogenous surplus, then, when its own production stops, a dependence starts on the external source: alcohol.
Who may become and alcohol abuser?
A total of 200 families of the province of Granada participated in the research. There was at least one chronic alcoholic parent in each family. From birth, each subject presented predetermined beta-endorphin levels. However, children of this population group aged between 6 months and 10 years old, registered lower beta-endorphin levels than other children of the same age. “These levels were even lower in children whose both parents were alcohol abusers”, the researcher states. According to researcher, although alcohol consumption does not affect all people in the same way, differences in endorphin levels make some subjects more vulnerable to alcohol. Therefore, they are more likely to become alcohol dependent.
Beta-endorphins constitute a useful biological marker to identify specifically those subjects who have a higher risk of developing alcohol abuse, the research claims. Regarding the results of this study, professor Rico states the following: “alcohol-abuse prevention must consist of locating and identifying genetically predisposed subjects.” More campaigns for children and teenagers should be launched before these young people make contact with alcohol. Alcohol awareness is fundamental to prevent addiction, the researcher affirms, because alcohol is a drug with reversible effects up to a point.
In relation to the “botellculture” (Botell’s a Spanish custom in which young people congregate in a park, street or any open public place to share alcoholic drinks and converse before entering bars, nightclubs, discos, etc.), José Rico states that some of these “social drinkers” could have low beta-endorphin levels and, therefore, a higher predisposition to become “solitary drinkers” and to develop alcohol abuse.

http://www.ugr.es/

Source:Newa-Medical.net 21st Dec. 2008

Drinking or smoking heavily can speed up the development of Alzheimer’s disease, according to a new study. Scientists found that drinkers developed the disease almost five years earlier and heavy smokers just over two years earlier, after studying 938 people aged 60 or more who had been diagnosed with Alzheimer’s.
Ranjan Duara, of the Mount Sinai Medical Centre in Miami Beach, Florida, said the results were significant “because it’s possible that if we can reduce or eliminate heavy smoking and drinking, we could substantially delay the onset of Alzheimer’s disease for people and reduce the number of people who have Alzheimer’s at any point in time”. He added: “It has been projected that a delay in the onset of the disease by five years would lead to a nearly 50% reduction in the total number of Alzheimer’s cases. In this study, we found that the combination of heavy drinking and heavy smoking reduced the age of onset of Alzheimer’s disease by six to seven years, making these two factors among the most important preventable risk factors for Alzheimer’s disease.”
Researchers gathered evidence of drinking history from family members and also looked at whether the participants had a particular variant of the APOE gene, which predisposes people to get Alzheimer’s earlier than normal. The results, presented yesterday at the American Academy of Neurology’s annual meeting in Chicago, showed that 7% of the participants were heavy drinkers, defined as more than two drinks a day; 20% had a history of heavy smoking, defined as smoking one pack of cigarettes or more a day; and 27% had the Alzheimer’s APOE gene variant.
Heavy drinkers developed Alzheimer’s 4.8 years earlier than those who were not heavy drinkers. Heavy smokers developed the disease 2.3 years sooner than people who were not heavy smokers. People with the APOE variant developed the disease three years sooner than those without it.
The researchers also looked at combined risk factors, and found that people that came into all three risk areas developed Alzheimer’s 8.5 years earlier than those with none of the risk factors.

Source: the Guardian Thursday April 17 2008

Almost half of all perpetrators of homicide were intoxicated, while alcohol related hospital discharges increased by 92%
The Health Service Executive (HSE), today, Monday 21st April, published a detailed review entitled “Alcohol Related Harm in Ireland.” The report outlines the recent rising trends in alcohol consumption rates, the harmful effects these rates are having on the user and the damaging results they have on other people.
The report provides an overview of recent studies into alcohol consumption, assesses the most up to date research into their effects and offers recommendations on how best to reduce the unhealthiest consequences.
Following four years of static alcohol consumption, in 2007 there was a rise of 2.7% per capita in individual alcohol consumption.
Some of the key findings of the report include:
Alcohol Related Harm to the Drinker:
• 28% of all injury attendances in Accident and Emergency Departments in acute hospitals were alcohol related;
• Alcohol related hospital discharges, which is an indicator of attendance, increased by 92% between 1995 and 2002;
• Cancer of the liver had the highest increase in cancer incidence rates in comparison to all cancers between 1994-2003;
• Almost half of men and over a quarter of women agreed that drinking alcohol had contributed to them having sex without contraception;
• Between 1995 and 2004, Sexually Transmitted Infections (STIs) increased by 217%;
• Alcohol is a contributory factor in 36.5% of all fatal crashes;
• Between 1996 and 2002, public order adult offences increased by 247% (from 16,284 to 56,822) followed by a decrease in 2003 and 2004 but increased again in 2005;
Alcohol Related Harm to Others:
• Almost half (46%), of those who committed homicide were intoxicated at the time;
• Between 1990 and 2006, 2,462 people were killed on the roads between 9pm-4am, the time most associated with alcohol related driving;
• 44% of all respondents had experienced harm by their own or someone else’s alcohol use;
• In a quarter of severe domestic abuse cases, alcohol was involved;
• The Coombe Women’s Hospital found that 63% of women reported alcohol use during pregnancy, with 7% drinking 6 or more drinks per week;
• IBEC cited that alcohol related illness was cited by 12% of companies as a cause of short-term absence from work for males and 4% for females;
Dr Joe Barry, HSE Population Health Directorate, said; “This report shows that alcohol related harm is not only confined to the negative consequences experienced by the drinker, such as illness and disease, but extends to others as well, which too often can lead to physical injury or even death. Inevitably, this also causes strain on health services and its staff who have to divert resources to treat avoidable alcohol related injuries and conditions.”
“The HSE provides a wide range of responses, from hospital and primary care services, through to specific alcohol and drug initiatives and public awareness and education campaigns. However, improvements in alcohol related harms in Ireland will require a sustained multi-sectoral response.”
Source: www.hse.ie 21st April 2008

Long-acting injections of the drug naltrexone, combined with psychotherapy, significantly reduced heavy drinking in patients being treated for alcohol dependence, according to a study in the Journal of the American Medical Association by a Yale School of Medicine researcher.

“The decision to take medication can wane over time,” said Stephanie O’Malley, professor of psychiatry and director of the Division of Substance Abuse Research at the Connecticut Mental Health Center at Yale. “This provides coverage for an entire month.”
Acohol dependence ranks as the fourth leading cause of disability worldwide, as reported by the World Health Organization’s Global Burden of Disease project. Nationwide, it is believed to contribute to more than 100,000 preventable deaths a year.
Naltrexone belongs to a class of drugs called opioid antagonists. Although many clinical trials have shown that oral naltrexone can be effective in treating alcohol dependence, its use in clinical practice has been limited, in part patients have to take the pill daily.
In this trial conducted at 24 sites, 627 alcohol dependent patients were randomly assigned to receive either an injection of long-acting naltrexone or a placebo injection; 624 ultimately received at least one injection. All participants received 12 counseling sessions during the six-month study in addition to the medication. Long-acting naltrexone was associated with a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six month treatment period.

Source:Yale University (2005, May 17). Once-a-month Naltrexone Successfully Used To Treat Alcohol Dependence. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2005/05/050517094735.htm

• Compared to 12- and 13-year olds who have frequent family dinners, those who have infrequent family dinners are six times likelier to use marijuana, four times likelier to use tobacco, and three times likelier to use alcohol.
• Compared to teens who attend religious services at least weekly, those who never attend services are more than twice as likely to try cigarettes, and twice as likely to try marijuana and alcohol.
• Compared to teens who have frequent family dinners, those who have infrequent family dinners are one and a half times likelier to report getting grades of C or lower in school. 

Source: www.casacolumbia.org   Sept.2009

Drinking alcohol at a young age, while the brain is still forming, causes cognitive and structural damage which could be irreversible.
“Studies have proven that alcohol causes brain atrophy,” said Dr. Nicole Gorman, a pediatrician at Village Pediatrics in Westport. “The bottom line is that alcohol stops brain cells from growing.”
Adolescence is the time when the hippocampus, the pre-frontal area of the brain located behind the forehead, is developing significant functions. These include forming its capacity for memory, thinking clearly, impulse control, spatial learning, planning and decision making. After spending more than two decades of analyzing the effects of alcohol on adolescents, the American Medical Association concurs that alcohol can produce both short term and, in many cases, long term damage.
Research studies concluded that teens who drink alcohol score considerably lower on tests involving their cognitive skills. These studies looked at their ability to process general information, including use of vocabulary and verbal and non-verbal information recall.
What is perhaps most alarming is that, according to its Web site, the brain might not be able to “catch up” once this crucial development phase is disrupted and altered by the presence of alcohol.
Dr. Joseph Russo of the Recovery Center of Westport explains that once the brain’s biochemical circuits get “hard-wired,” it’s difficult to alleviate the negative effects of substance abuse.
His colleague, Clarisse Loughrin, a substance abuse counselor, agreed. “The longer someone waits to start treatment the longer it will take,” she said. “And, when you start drinking and drugging at a younger age, the damage is greater and takes even longer.”
Along with physical consequences, alcohol also adversely affects a young person’s emotional growth. “Alcohol has a lot of depressive effects,” said Gorman. “In our practice, we already see many cases of depression in young people.” Teens who are suffering from depression might try to self-medicate themselves by binge drinking. Assuming that they are alleviating unwanted feelings, they are actually adding to their problem because alcohol is, in fact, a depressant.
Conversely, when people are abusing alcohol and drugs, it is more difficult to diagnose clinical depression, anxiety and other mood disorders. Studies have also linked underage drinking with a rise in violent behaviors and suicidal thoughts.
Gorman said that she also has young patients who come to her complaining of sleep disorders. However, this problem, too, is exacerbated by drinking alcohol”Someone might think that a drink or two will help them to sleep better but it’s actually only going to make things worse,” she said.
Characterized by risk-taking behaviors and low impulse control, adolescence is often a time when young people make poor behavioral choices. In attempting to break away from their parents and the embark on process of self actualization, teens could readily view drinking as a benign activity. In their struggle for independence, they defy parental authority with proclamations of “everyone is doing it” and “it won’t hurt me.”
Gorman cautions parents, though, about being “naive” and mistakenly thinking that an honors student or otherwise “good kid” could not be indulging in risky behaviors. “Alcohol should be placed in a locked place where kids do not have access to it,” Gorman said.
Source: www.westport-news.com 2nd Dec. 2009

Kudzu and its extracts and flowers have been used in traditional Chinese folk medicine to treat alcoholism for about 1,000 years. Kudzu contains daidzin, an anti-drinking substance. Daidzin inhibits human aldehyde dehydrogenase 2 (ALDH-2), which metabolizes alcohol into acetaldehyde. Inhibiting ALDH-2 promotes the accumulation of acetaldehyde, which has aversive effects. A recent test of a synthetic ALDH-2 inhibitor (CVT-10216) on rodents shows that it reduces drinking and prevents relapse by increasing acetaldehyde while drinking and later decreasing dopamine in the brain region that controls relapse during abstinence.

Results will be published in the November issue of Alcoholism: Clinical & Experimental Research .

“I think the over-arching issue here is medical treatment,” said Ivan Diamond, vice president of neuroscience at Gilead Science, Professor Emeritus of neurology, cellular and molecular pharmacology and neuroscience at the University of California, San Francisco, and corresponding author for the study.

“Alcoholism is a medical disorder, not just a problem of will power,” he said. “Physicians treat medical disorders in order to prevent harm, while not necessarily curing the disease being treated – for example, drug treatment of hypertension, statins for high cholesterol, insulin for diabetes – and the same will become true for treating alcoholism. Heavy drinking causes harm. We need to prevent heavy drinking in order to prevent harm.”

Diamond added that relapse may be the biggest problem facing physicians today. “We are talking about a patient who has the motivation to undergo a very unpleasant detoxification to try to stop drinking, and then gets into trouble afterward,” he said. “Nearly 80 percent of abstinent alcoholics or addicts relapse within a year. Current therapies for alcoholism help, but we can do much better.”

“Extracts of various parts of the kudzu vine have been used in many Chinese herbal medicine formulas and are said to be helpful in treating a variety of maladies, including alcoholism and intoxication,” said Ting-Kai Li, a professor in the department of psychiatry at Duke University Medical Center, and former director of the National Institute on Alcohol Abuse and Alcoholism. “Recent research has found that several compounds of the isoflavone family – puerarin, daidzin, daidzein – in the kudzu extract decrease alcohol intake in experimental animals.”

“Drs. Wing Ming Keung and Bert Vallee at Harvard were the first to confirm kudzu’s effects and isolate daidzin as the most potent of the isoflavones in kudzu,” added Diamond. “They went further by searching for the basis of daidzin’s anti-drinking properties, discovering that daidzin was a selective inhibitor of ALDH-2. Based on x-ray crystallographic studies of daidzin binding to ALDH-2, our team set out to design a compound that would interact more efficiently with ALDH-2, finally choosing CVT-10216 as our best candidate to date.”

Diamond and his colleagues administered CVT-10216 to groups of rats bred for moderate and high levels of drinking, after having exposed them to various scenarios of alcohol administration: two-bottle choice, deprivation-induced drinking, operant self-administration, and cue-induced reinstatement. The researchers then tested for blood acetaldehyde levels, alcohol-induced dopamine release in the nucleus accumbens, and effects of the inhibitor on drinking behavior and relapse.

“We had several key findings,” said Diamond. “We found that, one, CVT-10216 is a highly selective reversible inhibitor of ALDH2 without apparent toxicity. This means that it does not cause serious damage to other proteins and functions. Two, treatment with our ALDH-2 inhibitor increases acetaldehyde in the test tube and in living animals.” Acetaldehyde’s aversive effects can include a flushing reaction and feeling ill, which tend to reduce drinking. “And three, we found that our ALDH-2 inhibitor suppresses drinking in a variety of rodent drinking models.”

But that’s not the whole story, Diamond added. “Most importantly, we also found that CVT-10216 prevents the usual increase in drinking (binge drinking) that occurs after five days of abstinence, and also prevents relapse to drink, even when alcohol is not present. This means that something else besides acetaldehyde helps to suppress craving for, and prevent relapse to, drinking alcohol. We believe that ‘something else’ is dopamine.” He said that current concepts suggest that increased dopamine in the nucleus accumbens drives craving and relapse into drinking.

“Alcohol-induced increases in dopamine in the nucleus accumbens are prevented by CVT-10216 in a dose-dependent manner,” said Diamond. “This means the drug has a therapeutic effect in the brain, probably on the desire to drink. Importantly, CVT-10216 does not reduce basal dopamine levels when there is no stimulation to increase dopamine levels. This is consistent with our findings that CVT-10216 does not appear to affect moderate drinking, and does not have adverse side effects at the therapeutic doses used.”

“The findings show promise that CVT-10216 might be better tolerated than Antabuse™,” said Li. “How this happens is yet unknown, but suggests that the compound may be useful in treating alcohol relapse and perhaps for other psychoactive, potentially addictive compounds.”

Diamond agreed: “Disulfiram or Antabuse™ has been around for 50 years,” he explained. “It is called an ALDH-2 inhibitor, but it actually inhibits far more than that. Most believe that disulfiram would not be approved today as a new drug for alcoholism because of its many toxicities. Instead, we have developed CVT-10216, a reversible inhibitor with a very favorable profile, so far.” Diamond hopes this novel compound will become an effective therapeutic agent for alcoholism.

“The goal of medicine is harm reduction,” emphasized Diamond. “Excessive drinking causes harm while moderate drinking appears to be safe. Increasing numbers of doctors believe abstinence is an unrealistic goal. It sounds like heresy, but it isn’t. Therefore, an ideal drug might be able to prevent uncontrolled relapse, convert heavy drinkers into moderate drinkers, and avoid the harmful consequences of excessive alcohol intake. If our compound works and is safe to use, then I think most physicians would not hesitate to prescribe a new drug to prevent relapse and reduce heavy drinking. My goal is to make this happen.”

Ivan Diamond, M.D., Ph.D University of California, San Francisco.
Ting-Kai Li, M.D. Duke University Medical Center Alcoholism: Clinical & Experimental Research

Source: Medical News Today August 2009

Alcoholism Is Not Just A Medical Condition.
posted by Peter O’Loughlin on 14 Aug 2009
Professor Diamond’s views on alcoholism and relapse although interesting are not necessarily accurate. First the comment that alcoholism is a medical problem is a rather narrow concept of what is a complex mental and physical disorder, (DSM 1V & ICD-10) which causes serious medical problems. It is also a fact that alcoholics undergo personality changes. Therefore merely to treat the medical side of this condition is unlikely in and of itself to prevent relapse. Evidence in support of that can be found in a variety of Cochrane reviews of other ‘magic bullets’.

It is also debateable whether substances which appear to have desirable outcomes on rodents can be effective on human beings. As far as I’m aware the former, unlike the latter has no imagination or co-occurring mental disorders.

Professor Diamond’s comment regarding relapse rates does not tell the whole story. Whilst it is true that most relapses occur in the first year or two, that does not take into account the numbers who continue their battle with alcoholism and subsequently learn how to live their life without it.

There is no doubt that medicine has an important part to play in recovery, but there is also an abundance of evidence that many people find lasting sobriety without it. It is also true that abstinence alone is insufficient to prevent relapse, that for alcoholics to remain sober and to learn to live in a manner that they find personally satisfying, their mental and spiritual health needs have to be addressed. Abstinence alone is very fragile; recovery on the other hand is an ongoing process.

To assess the effect of alcohol use on prostate cancer risk, researchers analyzed data from 10,920 men participating in the Prostate Cancer Prevention Trial. Participants age 55 years or older and without prostate cancer were randomized to receive either finasteride or placebo and followed for 7 years. Baseline questionnaire data on quantity, frequency, and type of alcohol consumed were used to calculate average grams of ethanol per day. At baseline, 79% of subjects reported no drinking, 12% reported consumption of 0.1–14.9 g alcohol per day, 6% reported consumption of 15–49.9 g per day, and 2.4% reported consumption of ≥50 g per day.

• Prostate cancer was diagnosed in 2129 men (19.5%) during follow-up. Of these, 67% had low-grade cancer (Gleason score, 2–6), 26.5% had high-grade cancer (Gleason score, 7–10), and 6.5% had cancer of unknown grade.
• Compared with no alcohol use, heavy use (≥50 g per day) was associated with a significantly increased risk of total, low-grade, and high-grade prostate cancer in the finasteride group (relative risk [RR]=1.89, 2.01, and 2.15, respectively) and with a nonsignificant increased risk of high-grade cancer in the placebo group (RR=1.67). Lower levels of alcohol use were not associated with increased prostate cancer risk.
• Heavy beer and wine use were associated with increased prostate cancer risk, but liquor was not.
Comments:
This interesting study suggests that heavy alcohol use may increase prostate cancer risk and may also prevent a beneficial effect of finasteride on that risk. It should be noted that the threshold for increased risk in this study (50 g per day) is equal to about 4 standard drinks per day and, therefore, well above published hazardous drinking thresholds for men. Still, these results may be useful to clinicians when counseling their patients about lower-risk alcohol use and/or prostate cancer prevention. Kevin L. Kraemer, MD, MSc

Source:Gong Z, Kristal AR, Schenk JM, et al. Alcohol consumption, finasteride, and prostate cancer risk. Cancer. 2009;115(16):3661–3669.

Regardless of the explanation, the findings suggest “that there are very long-term benefits to a higher drinking age,” Norberg said.

From the Vietnam era until the mid-1980s, many states allowed people to purchase alcohol at the age of 18. However, a federal law pressured states to boost the drinking age to 21, and all did with the exception of Louisiana, which finally followed suit in the 1990s.

In the new study, Norberg and colleagues looked at surveys of 33,869 people born in the United States between 1948 and 1970. They examined the records to see if there were differences in alcoholism and drug abuse rates depending on when states allowed individuals to buy booze.

The study findings appear in an early online edition of the December issue of Alcoholism: Clinical and Experimental Research.

After adjusting their statistics to prevent things like the ethnicity of the respondents from skewing the results, the researchers found that those who lived in states that allowed drinking before age 21 were 1.3 times more likely to have suffered recently from alcoholism. They were also 1.7 times more likely to have had a recent drug abuse problem.

Norberg said lower drinking ages might have a “peer effect,” since that makes it easier to find friends of one’s age to drink with. “If the drinking age is at 21, it will be a little harder to find some friends to go out with. You’ll probably drink less often and have a smaller number of drinks.”

Because of widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health, the research team investigated how economic changes have affected mortality rates over the past three decades in European Union countries. The research team, which is comprised of researchers from the University of California, San Francisco; University of Oxford, and London School of Hygiene and Tropical Medicine, used data from the World Health Organization and the International Labor Organization. They analyzed more than 50 causes of death in 26 EU countries between 1970 and 2007 and compared the results to unemployment data. They also examined the different levels of government social spending during the same period, taking into account other factors that might affect rising death rates, such as population aging and the different ways that countries monitor employment rates and causes of death.

The stress of recessions, particularly of unemployment, seemed to markedly increase rates of death from intentional violence, with women particularly affected by homicide and men by suicide, according to study results.

“Suicides are just the tip of the iceberg” said lead author David Stuckler, PhD, of the University of Oxford and London School of Hygiene and Tropical Medicine. “Rising suicide rates are a sign of many failed suicide attempts and high levels of mental distress among workers and families.”

Employers need to be aware that workers often turn to alcohol during times of stress and need to be aware of the signs of alcohol abuse. For help on launching a workplace substance abuse prevention program, visit the Department of Labor’s Working Partners Web site.

Source: www.cadca.org Sept.l9 2009

A solid body of research has shown that raising the taxes and price of alcohol leads to a decrease in consumption by youth, and reduces alcohol-related deaths and illness. Increasing the total price of alcohol has also been shown to decrease drinking and driving among all age groups.The level of alcohol taxes and the rules for serving alcohol make a difference in underage and high-risk drinking. The taxes on beer, the drink of choice for the vast majority of underage drinkers, vary from $.02 per gallon in Wyoming to $1.07 per gallon in Alaska.

The five states with the highest beer taxes have significantly lower rates of teen binge drinking than the states with the lowest taxes.

Although raising alcohol taxes has proven to be effective, it is rarely used by states. According to the Center for Science in the Public Interest, most states’ alcohol taxes have not been raised in decades. With the effects of inflation taken into account, the current value of most state alcohol taxes is very low.

For example, in California alcohol taxes have fallen 49 percent in inflation-adjusted dollars since the last increase in 1991, according to the Marin Institute.

Some states that have raised alcohol taxes dedicate the proceeds to public health programs, including substance use treatment programs, prevention campaigns, and other public education efforts.

Source: www.Join Together.org Aug.2009

Heavy alcohol use is associated with an increased

risk of chronic pancreatitis, which may put patients

at risk for pancreatic cancer. In this study, an increased risk

was seen among subjects who reported either no alcohol

consumption (a group that probably contained former

drinkers) or consuming 3 or more drinks per day of liquor.

I agree with the conclusions of the authors that, although

moderate alcohol use was not a risk factor for pancreatic

cancer in this study, heavy alcohol use, particularly of liquor,

may play a role in its etiology. R. Curtis Ellison, MD

Source: Alcohol use and risk of pancreatic cancer: the NIH-AARP

Diet and Health Study. Am J Epidemiol. 2009;169(9):1043–1051.

Regular moderate alcohol consumption may be a protective

factor for cardiovascular disease. However, the effect

of alcohol consumption immediately prior to cardiovascular

events has not been studied extensively. Researchers conducted

a “case-crossover” study in 250 first-time nonfatal

acute myocardial infarction (AMI) cases to assess the influence

of alcohol consumption in the 12 hours preceding

AMI. Each case served as its own control; i.e., the control

information for each subject was based on his or her own

past behavior. The 12 hours preceding AMI was considered

the hazard period, while the corresponding time period a

week before AMI was the control period.

Drinking any alcohol in the hazard period increased

the risk for AMI threefold (odds ratio [OR], 3.1); even

moderate drinking (U24 g of ethanol for women and

U36 g for men) more than doubled it (OR, 2.3).

 Of the 187 subjects who drank any alcohol, 15 men

and 2 women reported heavy episodic drinking (4+

drinks per occasion for women and 5+ drinks for

men). The association between heavy episodic drinking

and AMI was not significant (OR, 3.0).

 These results were not influenced by known risk factors

for AMI (age, gender, smoking status, family history

of AMI, hypertension, hyperlipidemia, diabetes,

prior unstable angina pectoris, physical exertion

shortly before the event, psychological stress, or cocaine

use) in adjusted analyses.

 Compared with an age- and sex-matched general

population sample, subjects with AMI had more frequent

heavy episodic drinking (less than monthly, 21%

versus 11%; monthly or more, 7% versus 3%) and were

more likely to drink irregularly, i.e., less than weekly

(29% versus 16%).

Comments: Drinking any alcohol increased the risk for AMI in

the next 12 hours in this study. Researchers were not able

to demonstrate a significant association between heavy episodic

drinking and AMI due to the small number of exposed

subjects; however, the sample had higher rates of heavy and

irregular drinking compared with the general population,

giving some support to the hypotheses that heavy drinking

increases AMI risk, and that pattern of drinking is important

when assessing the risk for cardiovascular events. The relationship

between alcohol use and cardiovascular events is

likely not as simple as is commonly thought.

Source: Gerlich MG, Krämer A, Gmel G, et al. Patterns

Gerlich MG, Krämer A, Gmel G, et al. Patterns

of alcohol consumption and acute myocardial infarction: a

case-crossover analysis. Eur Addict Res. 2009;15(3):143–149

While most university students tend to “mature out” of heavy drinking by the time they’re young adults, some develop alcohol-use disorders, or AUDs. Most genetic research on family history of alcoholism has focused on alcohol use by the parents, most often the father.
But this study found that the density of family history of alcoholism (FHA) is much more effective.
“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem. The greater the number of affected relatives, the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students,” first author Christy Capone, a postdoctoral research fellow at Brown University’s Center for Alcohol and Addiction Studies, said in a prepared statement.
The study included 293 female and 115 male undergraduates from a northeastern U.S. university who completed an anonymous survey.
“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” Capone said. “Our other key finding was the relationship between FHA and other potential risk factors — behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”
“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” John Hustad, a research associate at Brown University, said in a prepared statement. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”
Capone said: “It is important to remember than not everyone with density of family alcoholism will go on to develop a long-term problem with alcohol themselves. Alcohol dependence is a very complex disorder, and FHA is but one influence on its development. However, college students who are heavy drinkers and have greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”
The study was published online in the journal Alcoholism: Clinical and Experimental Research and was expected to be in the August print issue.Source: (HealthDay News) June 4 2008

As a follow up to previous work showing that gene therapy can reduce drinking in rats trained to prefer alcohol, scientists at the U.S. Department of Energy’s Brookhaven National Laboratory have used the same technique to cut drinking in rats with a genetic predisposition for heavy alcohol consumption. The findings, along with additional results on the effects of long-term ethanol consumption on certain aspects of brain chemistry, are published in the May 2004 issue of Alcoholism Clinical and Experimental Research.”Though we are still early in the process, these results improve our understanding of the mechanism or mechanisms of alcohol addiction and strengthen our hope that this treatment approach might one day help people addicted to alcohol,” said Panayotis (Peter) Thanos, who lead the study in Brookhaven Lab’s medical department.
Genetically predisposed alcohol-preferring rats are a much better model for human alcoholism than the rats used previously, which the scientists had to train to prefer alcohol. Without any training, the genetic alcohol-preferring rats drink, on average, more than five grams of ethanol per kilogram of body weight per day when given a free choice between alcohol and plain water. Genetically non-preferring rats, in contrast, typically consume less than one gram of ethanol per kilogram of body weight per day.
In this study, both groups were treated with gene transfer to increase the level of a brain receptor for dopamine, a chemical important for transmitting feelings of pleasure and reward and known to play a role in addiction. After the gene treatment, the alcohol-preferring rats exhibited a 37 percent reduction in their preference for alcohol and cut their total alcohol consumption in half — from 2.7 grams per kilogram of body weight before treatment to 1.3g/kg after. Non-preferring rats also reduced their drinking preference and intake after gene treatment, but not in nearly as dramatic a fashion. The greatest reductions in alcohol preference and consumption were observed within the first few days after gene treatment, and both preference and consumption returned to pre-treatment levels by day 20.
The gene administered was for the dopamine D2 receptor, a protein shown in various studies to be relevant to alcohol and drug abuse. For example, low levels of dopamine D2 receptors in the brain have been postulated to lead to a reward deficiency syndrome that predisposes certain people to addictive behaviors, including drug and alcohol abuse. The alcohol-preferring rats used in this study have about 20-25 percent lower levels of dopamine D2 receptors when compared to the non-preferring rats, which may, in part, explain their tendency toward heavy drinking.
The scientists delivered the gene by first inserting it into a virus that had been rendered harmless. They then injected the virus directly into the rats’ nucleus accumbens, the brain’s pleasure center. The idea behind this type of gene therapy is to use the virus as a vector to carry the gene to the brain cells, which can then use the genetic instructions to make the D2 receptor protein themselves.
As an additional measure in this study, the scientists used micro-positron emission tomography (microPET) imaging to non-invasively assess the effects of chronic alcohol consumption on D2 receptor levels in alcohol-preferring and non-preferring rats. They measured D2 levels seven weeks after the gene therapy treatment (well after the effects of gene therapy had worn off). D2 receptor levels in alcohol-preferring rats were significantly lower (about 16 percent) compared to that in non-preferring rats. These levels were similar to previous data in naïve preferring and non-preferring rats.
In future studies, the D2 connection to alcoholism will be examined in transgenic mice that are totally depleted of D2. In addition, the scientists plan to develop a second generation D2 vector approach that will provide a longer period of treatment.
“These findings further support our hypothesis that high levels of D2 are causally associated with a reduction in alcohol drinking and may serve as a protective factor against alcoholism,” Thanos said.
###
This study was funded by the Office of Biological and Environmental Research within the Department of Energy’s Office of Science and by the National Institute of Alcohol Abuse and Alcoholism within the National Institutes of Health.
One of the ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE’s Office of Science by Brookhaven Science Associates, a limited-liability company founded by Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization. Visit Brookhaven Lab’s electronic newsroom for links, news archives, graphics, and more: http://www.bnl.gov/newsroom
Previous related study: http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr090501.htm

Source: Brookhaven National Laboratory (2004, May 6). Gene Therapy Reduces Drinking In Rats With Genetic Predisposition To ‘Alcoholism’. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2004/05/040506070752.htm

Scientists have identified a brain mechanism in rats that may play a central role in regulating anxiety and alcohol-drinking. The finding, by researchers supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), could provide important clues about the neurobiology of alcohol-drinking behaviors in humans..”This is an intriguing finding,” notes NIAAA Director Ting-Kai Li, M.D. “These experiments, conducted in rats selectively bred to have a high affinity for alcohol, help us address questions about the potential role that anxiety might play in human alcoholism. These molecular studies also may reveal potential targets for therapy of anxiety and alcoholism.”
Some researchers have suggested that high levels of anxiety may predispose some individuals to becoming alcoholic.
Researchers led by Subhash C. Pandey, Ph.D., Associate Professor and director of neuroscience alcoholism research in the Department of Psychiatry at the University of Illinois and Jesse Brown VA Medical Center in Chicago, found that “P” rats, a strain bred to prefer alcohol, showed more anxiety-like behaviors and drank more alcohol, than non alcohol-preferring “NP” rats. They measured anxiety in the rats with an apparatus known as an elevated plus-maze, which consists of two open arms and two closed arms connected to a central platform. Anxiety is gauged as a function of the amount of time a rat spends in the closed versus the open arms of the maze during a 5-minute testing period — the greater an animal’s level of anxiety, the less open-arm activity it displays.
Dr. Pandey and his colleagues also found that levels of CREB, a protein involved in a variety of brain functions, were lower in certain brain areas of P rats compared with NP rats. Levels of neuropeptide Y (NPY), a molecule that regulates the function of several neurotransmitters and is known to play a role in anxiety and alcohol-drinking behaviors, also were lower in P rats. One function of CREB is to regulate the production of NPY.
“Compared to NP rats, levels of CREB and NPY were innately lower in the central amygdala and medial amygdala of P rats,” explains Dr. Pandey, “brain areas which play a crucial role in anxiety behaviors and which have been shown previously to be involved in rewarding, reinforcing, and motivational aspects of alcohol drinking behaviors. And turning off CREB function in the central amygdala of NP rats makes them look like P rats — more anxious and thus more likely to drink.”
Alcohol intake reduced anxiety-like behaviors in the P rats, an effect that was associated with increased CREB function and NPY production in the central and medial amygdala. And by administering compounds that promote CREB function and NPY production in the central amygdala, researchers were able to reduce anxiety — and alcohol intake — in P rats. On the other hand, by disrupting CREB function (and the concomitant NPY production) in the central amygdala of NP rats, the researchers were able to provoke anxiety-like behavior and promote alcohol intake in those animals.
Dr. Pandey and his colleagues proposed that decreased CREB-dependent NPY production in the central amygdala might be a pre-existing condition for anxiety and alcohol-drinking behaviors.
“Our findings implicate this pathway in genetic predisposition to high anxiety and alcohol-drinking behaviors of P rats,” says Dr. Pandey. “Future studies should explore the relationship of other CREB-related compounds to these phenomena in P rats or other animal models.”

Source: NIH/National Institute on Alcohol Abuse and Alcoholism (2005, October 5). Researchers Shed Light On Anxiety And Alcohol Intake. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2005/10/051005080853.htm

Reshaping of the DNA scaffolding that supports and controls the expression of genes in the brain may play a major role in the alcohol withdrawal symptoms, particularly anxiety, that make it so difficult for alcoholics to stop using alcohol.The finding is reported by researchers at the University of Illinois at Chicago and the Jesse Brown VA Medical Center in the April 2 issue of the Journal of Neuroscience.
DNA can undergo changes in function without any changes in inheritance or coded sequence. These “epigenetic” changes are minor chemical modifications of chromatin — dense bundles of DNA and proteins called histones.
“This is the first time anyone has looked for epigenetic changes related to chromatin remodeling in the brain during alcohol addiction,” said Dr. Subhash C. Pandey, professor and director of neuroscience alcoholism research at the UIC College of Medicine and the Jesse Brown VA Medical Center in Chicago, the lead author of the study.
Chemical modification of histones can change the way DNA and histones are wound up together. Histone acetyltransferases (HATs) are enzymes that add acetyl groups to histones and loosen the packing, promoting gene expression. On the other hand, histone deacetylases (HDACs) remove acetyl groups from histones, causing them to wrap with DNA more tightly, decreasing gene expression.
The UIC researchers had previously shown in an animal model that levels of neuropeptide Y in the amygdala modulate anxiety and alcohol-drinking behavior. In the new study, they looked at the HDAC activity, acetylation of histones, and expression of the genes for NPY in the amygdala and the anxiety-like behaviors associated with withdrawal from chronic alcohol use.
Pandey and his colleagues found that acute exposure to alcohol decreases HDAC activity; increases the acetylation histones; increases levels of NPY — and reduced anxiety in the animals.
Conversely, anxiety-like behaviors during withdrawal in animals with chronic alcohol exposure was associated with an increase in HDAC activity and decrease in histones acetylation and NPY levels.
Importantly, blocking the observed increase in HDAC activity using an HDAC inhibitor during alcohol withdrawal brought up histone acetylation and NPY expression levels in the amygdala and prevented the development of anxiety-like behaviors.
“Our findings suggest that HDAC inhibitors may have potential as therapeutic agents in treating alcoholism,” Pandey said.
The researchers also found that levels of a protein known as CREB binding protein, which has HAT enzymatic activity, were increased by acute alcohol but were decreased during ethanol withdrawal.
They concluded that the enzymes that are involved in remodeling of chromatin play an important role in the anxiety that accompanies alcohol withdrawal as well as in the anti-anxiety effects of acute alcohol use.
“We need new strategies to treat alcoholism that are directed toward the prevention of withdrawal symptoms,” Pandey said. “Anxiety associated with withdrawal from alcohol abuse is a key factor in the maintenance of alcohol addiction.”

Source: University of Illinois at Chicago (2008, April 4). Brain DNA ‘Remodeled’ In Alcoholism. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/04/080402084340.htm

Doctors may one day be able to control alcohol addiction by manipulating the molecular events in the brain that underlie anxiety associated with alcohol withdrawal, researchers at the University of Illinois at Chicago College of Medicine and the Jesse Brown VA Medical Center report in the March 5 issue of the Journal of Neuroscience.”The association of anxiety with increased alcohol use is a key factor in the initiation and maintenance of alcohol addition,” says Dr. Subhash Pandey, UIC professor of psychiatry and director of neuroscience alcoholism research, the lead author of the study.
Previous research has shown that people with inherently high levels of anxiety are at an increased risk of becoming alcoholics. In addition, withdrawal of alcohol in chronic users is often accompanied by extreme anxiety.
“Alcoholics may feel a need to continue to drink alcohol in an attempt to self-medicate to reduce their anxiety and other unpleasant withdrawal symptoms,” said Pandey.
Pandey and his colleagues have discovered the molecular basis for the link between anxiety and alcohol addiction, which may help in identifying new therapeutic strategies for the treatment of alcohol addiction.
The researchers found that a protein within neurons in the amygdala — the area of the brain associated with emotion and anxiety — controls the development of alcohol withdrawal symptoms and drinking behaviors in laboratory animals by changing the shape of the neurons. This change in shape affects the communication between neurons, leading to changes in behavior.
Neurons communicate by sending signals through branches called dendritic spines. The researchers found that short-term alcohol exposure increased the number of dendritic spines in certain regions of the amygdala, producing anti-anxiety effects. Alcohol-dependent animals eventually developed a tolerance to the anxiety-lowering effects of alcohol.
The researchers traced the anti-anxiety effect to the production of a particular protein, Arc, in response to a nerve growth factor called BDNF that is stimulated by alcohol exposure. BDNF is vital in the functioning and maintenance of neurons.
When alcohol was withheld from animals that had been chronically exposed, they developed high anxiety. Levels of BDNF and Arc — and the number of dendritic spines — were decreased in the amygdala. But the researchers were able to eliminate the anxiety in the alcohol-dependent animals by restoring BDNF and Arc to normal levels.
Pandey suggested that an initial easing of anxiety may encourage people to begin to use alcohol, while for chronic users, a lack of alcohol provokes high anxiety, creating a need to continue drinking to feel normal.
The researchers blocked Arc production in normal rats by injecting a complementary sequence to Arc gene DNA into the central amygdala. They found that when levels of Arc in the central amygdala were lowered, the spines decreased and anxiety and alcohol consumption increased. When levels of Arc were returned to normal three days post-injection, anxiety and alcohol consumption also returned to normal. In a previous study, researchers found that lowering BDNF in amygdala promoted anxiety and alcohol drinking.
“This is the first direct evidence of the molecular processes occurring in the neurons that is responsible for the co-morbidity of anxiety and alcoholism, which we believe plays a major role in the addictive nature of alcohol,” said Pandey.
“This offers the possibility of new therapeutic target — BDNF-Arc signaling and associated dendritic spines in the amygdala — or new drug development.”
“These observations by Dr. Pandey’s research group provide an insight into the link between alcohol and anxiety and could be used to identify new targets for developing medications that alleviate withdrawal-induced anxiety and potentially modify a motivation for drinking,” said Antonio Noronha, director of neuroscience and behavior research at the National Institute on Alcohol Abuse and Alcoholism.
The work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the Department of Veterans Affairs. Huaibo Zhang, Rajesh Ugale, Anand Prakash, Tiejun Xu and Kaushik Misra of the UIC College of Medicine and the Jesse Brown VA Medical Center also contributed to the study.

Source: University of Illinois at Chicago (2008, March 5). Brain Chemistry Ties Anxiety And Alcoholism. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/03/080304173356.htm

Long-acting injections of the drug naltrexone, combined with psychotherapy, significantly reduced heavy drinking in patients being treated for alcohol dependence, according to a study in the Journal of the American Medical Association by a Yale School of Medicine researcher.
“The decision to take medication can wane over time,” said Stephanie O’Malley, professor of psychiatry and director of the Division of Substance Abuse Research at the Connecticut Mental Health Center at Yale. “This provides coverage for an entire month.”
Acohol dependence ranks as the fourth leading cause of disability worldwide, as reported by the World Health Organization’s Global Burden of Disease project. Nationwide, it is believed to contribute to more than 100,000 preventable deaths a year.
Naltrexone belongs to a class of drugs called opioid antagonists. Although many clinical trials have shown that oral naltrexone can be effective in treating alcohol dependence, its use in clinical practice has been limited, in part patients have to take the pill daily.
In this trial conducted at 24 sites, 627 alcohol dependent patients were randomly assigned to receive either an injection of long-acting naltrexone or a placebo injection; 624 ultimately received at least one injection. All participants received 12 counseling sessions during the six-month study in addition to the medication. Long-acting naltrexone was associated with a reduction in heavy drinking within the first month of treatment, and this response was maintained over the six month treatment period.Source: Yale University (2005, May 17). Once-a-month Naltrexone Successfully Used To Treat Alcohol Dependence. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2005/05/050517094735.htm

Patients with a certain gene variant drank less and experienced better overall clinical outcomes than patients without the variant while taking the medication naltrexone, according to an analysis of participants in the National Institutes of Health’s 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) Study. About 87 percent of patients with the variant who received naltrexone experienced good outcomes, compared with about 49 percent of those who received a placebo. About 55 percent of patients without the variant experienced a good outcome regardless of whether they received naltrexone or placebo. Good outcome was defined as abstinence or moderate drinking without related problems, according to an article in the Feb. 4 issue of the Archives of General Psychiatry.Drinking alcohol increases the release of endogenous opioids, compounds that originate in the body and promote a sense of pleasure or well-being. An opioid antagonist, naltrexone blocks brain receptors for endogenous opioids, making it easier for patients to remain abstinent or stop quickly in the event of a slip. In clinical studies, naltrexone has been shown to reduce relapse and craving for alcohol in some but not all treated patients. Earlier studies had suggested that a specific DNA variant of the opioid receptor gene (OPRM1) might have role in patients’ response to naltrexone.
“Analysis of the large COMBINE patient population increases confidence that the OPRM1 variant is in part responsible for positive responses to naltrexone. This study points to the promise of research on gene-medication interactions to refine treatment selection, improve clinical results, and inform ongoing medications development,” said National Institute on Alcohol Abuse and Alcoholism (NIAAA) director Ting-Kai Li, M.D.
Of the original 1383 COMBINE Study participants, 1013 were available to be genotyped for the current study, conducted by Raymond F. Anton, M.D., Medical University of South Carolina, and other COMBINE Study principal investigators in collaboration with David Goldman, M.D., and his colleagues in NIAAA’s Laboratory of Neurogenetics. The researchers successfully genotyped 911 of the available patients and conducted their initial analysis in 604 who are white, 135 of whom were found to carry the genetic variant. Approximately 15 to 25 percent of humans carry the variant, with considerable variation among ethnicities.
As in the COMBINE clinical trial, drinking variables evaluated in the pharmacogenetic study included the percentage of days abstinent from alcohol, the percentage of heavy drinking days, and clinical outcome during 16 weeks of active treatment. In addition to naltrexone or placebo, all patients received medical management (nine brief, structured outpatient sessions delivered by a health professional) and some also received a combined behavioral intervention (integrated cognitive-behavioral and motivational enhancement therapies, together with techniques to enhance mutual-help participation).
The researchers found that, compared with patients who do not carry the variant, white variant carriers who received naltrexone fared substantially better than other groups on all measures, including almost a 6 times greater likelihood of good clinical outcome. Extending the clinical outcome measure to variant carriers of all ethnicities reduced the benefit to just over a 3 times greater likelihood of good outcome. The researchers found no gene-medication interaction in patients who received specialized alcohol counseling, leading to them to conclude that genotyping for the variant may be most useful when naltrexone is used without intensive counseling.
Approved by the U.S. Food and Drug Administration in 1994, naltrexone is one of three indicated medications* shown to help patients reduce drinking, avoid relapse to heavy drinking, achieve and maintain abstinence, or gain a combination of these effects. The COMBINE trial showed either specialized counseling or naltrexone–each delivered with medications management–to be effective options for treating alcohol dependence. “Given that alternative treatments such as combined behavioral interventions, acamprosate, and topiramate can be offered, one could make the case that naltrexone should be used first or used primarily in carriers of the OPRM1 [variant],” state the authors.
“Research studies designed to ensure appropriate medication targeting are critical, especially as treatment for alcohol use disorders increasingly involves primary care physicians as well as specialists,” notes Mark L. Willenbring, M.D., director of NIAAA’s Division of Treatment and Recovery Research. “Without the ability to predict response for a specific patient, we must use trial-and-error to determine the correct medication–a process that may prolong illness and lead to more side effects. This study highlights the promise of truly personalized medicine and could help to move treatment of alcohol dependence into the medical mainstream.”

Source: NIH/National Institute on Alcohol Abuse and Alcoholism (2008, February 12). Gene Variant Predicts Medication Response In Patients With Alcohol Dependence. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com¬ /releases/2008/02/080207172332.htm

A new study from the Telethon Institute for Child Health Research has revealed the consequences of heavy and binge drinking on pregnancy even after these drinking patterns have stopped.
 
The study, to be published in BJOG: An International Journal of Obstetrics and Gynaecology, investigated the relationship between prenatal exposure to alcohol and the effects on fetal growth and preterm birth. 
 
A random sample of 4,719 women who gave birth in Western Australia between 1995 and 1997 took part in a survey.  Data such as how often participants drank alcohol, the amount of alcohol consumed in each occasion and the types of alcoholic beverage consumed were collated.    
 
The researcher team from the Institute with the National Perinatal Epidemiology Unit at the University of Oxford found that, on average, levels of alcohol intake decreased from the pre-pregnancy period to the second and third trimester.  There was no difference in outcomes for women who drank low levels of alcohol during their pregnancy and those that abstained. 
 
The incidence of preterm birth was highest amongst women who binged (9.5%) or drank heavily, even if the mother stopped drinking prior to the second trimester (13.6%), compared with less than 6% in women who did not drink during pregnancy.  There was a 2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy but then stopped (CI 0.7, 7.7) after taking into account maternal smoking, drug use, socioeconomic status and maternal health. Researchers suggest that a possible reason why this occurs is because the cessation of alcohol consumption before the second trimester may trigger a metabolic or inflammatory response resulting in preterm birth.  There was no evidence of an increased likelihood of preterm birth at low levels of alcohol consumption. 
 
Prenatal alcohol exposure did not increase the risk of babies being born small for gestational age once maternal smoking was accounted for.
 
Researchers noted a link between smoking and alcohol consumption – they found women who smoked during pregnancy were less likely to abstain from alcohol at any time during their pregnancy than non-smokers.  Over one quarter (27.7%) of women who drank in late pregnancy also smoked, compared with 19% of women who had abstained from alcohol during pregnancy.  Other factors associated with late term pregnancy drinking include: a maternal age of 30 years and above, higher income, use of illicit drugs.
 
Institute researcher Colleen O’Leary said “Our research shows pregnant women who drink more than one to two standard drinks per occasion and more than six standard drinks per week increase their risk of having a premature baby, even if they stop drinking before the second trimester.
 
“The risk of preterm birth is highest for pregnant women who drink heavily or at binge levels, meaning drinking more than seven standard drinks per week, or more than five drinks on any one occasion.
 
“Health professionals should routinely screen pregnant women and all women of child bearing age for alcohol use/misuse.  It’s important that women should be given information about the possible risks to the baby from alcohol exposure during pregnancy.
 
“Women should be advised that during pregnancy, drinking alcohol above low levels increases the risk to the baby and that the safest choice is not to drink alcohol during pregnancy.  If pregnant women cannot stop or reduce their drinking, they should seek medical advice.”
 
[A standard drink in this analysis is the Australian standard10gm of alcohol, eg 100ml of wine]
 
Professor Philip Steer, BJOG editor-in-chief said, “This study provides useful insight into the drinking habits of a representative group of women.  It is very telling how the combination of smoking and heavy drinking can mean double trouble for pregnant mothers and their babies.      
 
“It shows the effects of high alcohol use and demonstrates that heavy and binge levels of alcohol during pregnancy increases the risk to the baby, even if drinking is stopped in the first three months of pregnancy. These findings are sobering and should act as a deterrent to heavy or binge drinking during pregnancy. However, the results also show that low levels of alcohol consumption (less than 7 standard drinks per week and no more than two on any one occasion) appeared not to constitute a significant risk of preterm birth provided all other forms of unhealthy behaviour were avoided.”  
 
Source: Telethon Institute for Child Health Research  21st Jan.2009

AUSTRALIANS who have more than four drinks on any one occasion sharply increase their risk of serious harm, the Federal Government’s new alcohol guidelines state.And people who regularly consume more than two drinks a day seriously heighten their risk of death from alcohol-related disease or injuries.
The National Health and Medical Research Council’s guidelines also express concerns about youth binge drinking, stating there is no safe level of alcohol consumption for people under 18, and warning parents against giving older children small amounts of alcohol.
The guidelines, obtained by The Sunday Age, have been softened since a controversial October 2007 draft stated that two drinks a day constituted an immediate health risk.   But the new guidelines reverse the advice in the draft that 15-to-17-year-olds could consume some alcohol under parental supervision. Parents are also warned that alcohol is particularly dangerous for under 15s and they should try to delay drinking by their teenagers for as long as possible.
The new four-drink guideline for a one-off celebration has been added in response to public angst about youth binge drinking and violence, and refers to risk of injury due to drunkenness as well as long-term health damage.   The document, which will be released on February 26, almost a year overdue, states: “In view of growing community concern about harm arising from single occasions of drinking, particularly among young people, the NHMRC undertook to also set a guideline on reducing the risk of injury on single occasions of drinking.”
Sectors of the alcohol industry, which vigorously opposed the first draft, welcomed the new guidelines. Steve Riden from the Distilled Spirits Industry Council of Australia said the guidelines “have improved significantly from those originally proposed”.
Evidence presented in the guidelines state that regularly having two drinks a day puts the lifetime risk of death from alcohol-related disease at about 0.4 in 100. Above that level the risk rises to one in 100 and continues to escalate with every drink. It also states having four drinks in one sitting more than doubles the chance of injury in the six hours afterwards.
A senior NHMRC source said: “These are not insignificant risks. This is injury sufficient enough to cause hospitalisation or death; we’re not talking about stubbing your toe as you leave the pub.”
Completion of the guidelines had been delayed as the committee tried to make the advice easier to understand. “Essentially, what the guidelines say is that if you try and aim for two drinks a day, then as a pattern over a lifetime you keep your risk relatively low. Above that, your risk rises.
“If you drink more than four on any one occasion, your risk starts to rise on that occasion … no one is saying this is what you have to do; it’s just trying to get health information out to the public in the same way as we do with blood pressure, weight or exercise.”

Source:  TheAge.com.au  1st Feb. 2009

Specialist liver services are already at full capacity and demand is growing as increasing numbers of younger people fall ill due to their drinking, according to doctors writing in the journal Clinical Medicine.
A questionnaire of gastroenterologists revealed that the majority of hospitals have only have the number of specialist doctors needed for the expected workload of an average local hospital. There is also shortages of specialist nurses, radiologists, pathologists and psychiatrists, the study said.
Author of the study Dr Michael Williams, Specialist Registrar at Derby Digestive Diseases Centre, Derby City General Hospital said the shortages will affect patient care and hospitals should be organised into networks as recommended by the National Plan for Liver Services.   Professor Ian Gilmore, President of the Royal College of Physicians, Professor of Medicine and consultant gastroenterologist at Royal Liverpool University Hospitals said: “Liver disease is increasing and the majority of the increase is alcohol-related.
“Deaths from alcohol-related liver disease are continuing to rise and across all liver disease deaths have gone up ten fold since the 1970s.  Liver disease stands out starkly as an increasingly common cause of death at a time when improvements in health are being seen in other areas. Many deaths are avoidable with specialist care but our hospitals services have not kept pace with this rising tide of liver disease.
“We need to urgently implement the national plan to remedy this.”
Prof Gilmore said the Government was taking action on alcohol labelling and selling at discounts but more needed to be done as drink has never been more available or cheaper than it is now.
He said the best way to bring down harmful alcohol consumption would be to introduce a minimum price per unit as this would not affect the middle market wines but would hit the cheap strong ciders and lagers which are often drunk to excess.

Source: www.Telegraph.co.uk  4rh Feb.2009

The damage caused by expectant mothers who drink during pregnancy is costing Canada more than $5 billion a year, a report says.
Fetal Alcohol Spectrum Disorder (FASD) impacts one in 100 children, or almost 243,000 Canadians, causing low birth weight, restricted growth, physical and mental disability and, in some cases, heart problems.
Doctors dealing with the disorder say there is a dire need for more diagnostic services and warn that even with government intervention, FASD will carry a high price tag for generations.
“We all know one drink is not going to cause FASD,” says Dr. Brenda Stade, the head of the FASD clinic at Toronto’s St. Michael’s Hospital who co-wrote the paper, published in the January edition of the Canadian Journal of Clinical Pharmacology. “Bottom line, you should abstain if you can. If you can’t, you should go to your family doctor and try to cut down.”
Eight-year-old Caitlyn Nugent was born addicted to alcohol after her mother sipped vodka coolers throughout her pregnancy. Her 10-year-old sister Chrystal isn’t as badly affected but has also been diagnosed with conditions classified under FASD, an umbrella term for a variety of mental, physical and behavioural problems linked to drinking during pregnancy, including Fetal Alcohol Syndrome.
“The children do look normal, but they don’t act normal,” says their grandfather, Doug Nugent, who with his wife Larraine have raised the girls since they were babies in Toronto. Their son is the girls’ father. “There is a lot of confusion about their behaviour … they are not spoiled brats. It’s just brain damage.”
Some FASD children bear hallmark facial features, including smaller and wide-set eyes, a thin upper lip and no groove between the nose and lip. But many don’t, which is why their behaviour is often misunderstood well into adulthood. “These people have been struggling for years and nobody can really recognize their disability,” says Stade, who has adopted a child with the disorder. The clinic opened six years ago and diagnoses about 400 patients every year, of all ages. They are expanding to meet demand.
The report by the Hospital for Sick Children, the Public Health Agency of Canada and St. Mike’s, involved interviews with 250 caregivers of children and adults with FASD on the costs of emergency medical care, health services, education and out-of-pocket spending, including medication and recreational activities. FASD is a recognized disability so the costs of the Ontario Disability Support Program were included. No one knows exactly how much alcohol causes the disorder. To prevent confusion over what could be safe, most experts advise pregnant women not to drink at all.
Every child’s condition and needs are different and complicated, Stade says. Mental impairment includes behavioural issues, problems learning and impaired social skills and judgment.
But many children with the disorder, she says, are socially adept, using small talk to fit in and, given the proper support, can function well in certain positions, including some trades. But getting to that point requires a tremendous amount of support.
Doug and his wife are both 57. But, he says, “my retirement started six years ago, once the kids came. I couldn’t go out and work full-time.”
Caitlyn and Chrystal have serious dental problems and “their immune system is zilch,” says their grandfather. They both require inhalers and are constantly battling infections. They have had speech and physical therapy and need sensory integration therapy – essentially exposing them to a barrage of sensations to teach them to respond properly to stimuli.
FASD children have trouble focusing, says Doug.
“The teachers, they can’t understand why the kids are not capable of doing work … the signal doesn’t get through properly.”
It’s easy, Doug says, for outsiders to find fault with a child affected by FASD. Caitlyn and Chrystal have difficulty understanding social cues, it’s hard for them to play with other children and they are prone to severe mood swings. “I’m a little bit scared for the girls when they start the next level of school. The social aspects of the higher-level schools scare me, because these children are so vulnerable,” he says.
Of their teenage years, Larraine says: “I’m really dreading them because they are such followers … it doesn’t matter how much you try to streetwise them. It is going to be hard.” She and her husband’s main goal is to raise awareness and get the government to provide funding for early services and therapies for kids with FASD and their families.
That is why they invited the Star into their home to speak about the girls. They have applied twice to the province’s Family Responsibility Office to get coverage for dental care and prescription medication. They were rejected both times, told incorrectly that FASD is not a recognized disability and that being grandparents disqualifies them.
“I would love to tell the government to live with these children themselves,” says their grandfather. “It’s banging your head up against a brick wall, trying to get acceptance for these children … they need assistance.”

Source: TheStar.com  3rd March 2009

Down in your cups? … researchers find a link between alcohol dependency and depression.
Excessive alcohol drinking may increase the risk of depression, a long-term study conducted over 25 years in New Zealand has found.
The study, published in the Archives of General Psychiatry, involved a group of 1,055 children who were monitored and interviewed at various times over 25 years.
“At all ages, there were clear and statistically significant trends for alcohol abuse or dependency to be associated with increased risk of major depression,” wrote the researchers, led by David Fergusson at the University of Otago’s department of psychological medicine.
The study found 19.4 percent of the participants between 17 and 18 were either abusing or dependent on alcohol, and 18.2 percent were diagnosed with depression.
“Individuals who fulfilled the criteria for alcohol abuse or dependency were 1.9 times more likely to also fulfill the criteria for major depression,” the researchers wrote.
The link between the two was significant even after factoring in other possible causes, such as use of cannabis and other illegal drugs, affiliation with “deviant peers,” unemployment and a partner who committed crimes.
“It has been proposed that this link may arise from genetic processes in which the use of alcohol acts to trigger genetic markers that increase the risk of major depression,” the researchers said.
“Further research suggests that alcohol’s depressant characteristics may lead to periods of depressed effect among those with alcohol abuse or dependency.”

Source:  theAge.com.au  3rd March 2009

All those T-shirts, hats and other items promoting alcoholic beverages that young people wear may be more than just a fashion statement.   Teens who own such merchandise are more likely to start drinking and become binge drinkers, a new study contends.
The Dartmouth scientists who did the research said this is the first study directly linking alcohol-branded merchandise to adolescent drinking and outcomes such as binge drinking that can result in illness and death. In addition, the data provide evidence that this merchandise promotes teen drinking and could be a basis for enacting policies to restrict this alcohol-marketing practice, the researchers said.
“About 3 million adolescents in the United States own alcohol-branded merchandise,” said lead researcher Dr. Auden C. McClure, a pediatrician at Dartmouth Hitchcock Medical Center in Hanover, N.H. “Ownership of these items is associated with susceptibility to alcohol use and binge drinking,” she added.
These items serve as a marker for adolescents who drink, McClure said. “But it is also a direct link with susceptibility and initiation to drinking,” she said. “You can’t say any longer that these items are just a marker of kids who drink.”

Source:Archives of Pediatrics & Adolescent Medicine.  arch 2009

JUST two alcoholic drinks a day can increase the risk of pancreatic cancer, a study has shown.
Consuming 30g or more of alcohol a day raises the likelihood of developing the disease by 22 per cent, scientists found.

That is the equivalent of roughly two drinks, according to the US researchers. They defined “a drink” as 12 fluid ounces of  beer, four fluid ounces of wine or 1.5 fluid ounces of spirits.

The investigation was one of the largest ever to examine dietary factors influencing pancreatic cancer.   Scientists analysed data from 14 studies looking at the food and drink consumption of more than 860,000 men and women.

Of these, 2,187 were diagnosed with pancreatic cancer.

Dr Jeanine Genkinger, from Georgetown University in Washington DC, said: “Our findings support multiple nutrition recommendations that men should limit intake to no more than two alcoholic beverages a day and women to one.”

Previous studies had been unable to confirm an association between alcohol consumption and pancreatic cancer risk.

The link was suspected because drinking is associated with pancreatitis, inflammation of the pancreas and diabetes. Both conditions are known risk factors for pancreatic cancer.

Source:  News.Scotsman.com  4th March 2009

The number of 11 to 18 years old in London admitted to hospital for alcohol-related illnesses has risen.
Admissions increased from 1,171 in 2002/03, to 1,769 in 2006/07, according to figures obtained for a report.
The ‘Highs and Lows’ report by the Greater London Alcohol and Drug Alliance said less young Londoners are using drugs, particularly cocaine.
London Mayor Boris Johnson said the fall in cocaine use over the last couple of years was encouraging.
The report said the proportion of young Londoners between 16 and 24 who reported using any drug use during the last year decreased between 2005/06 and 2007/08 – from 20.3% to 17.8%.
And the proportion of young Londoners who reported using cocaine is down from 7.1% in 2005-06 to 4.7% in 2007-08.
Widespread problems
The report also said the estimated numbers of problem drug users – those whose drug use has taken over their lives – in this age group dropped from 14,068 in 2004/05 to 11,750 in 2005/06.
Mr Johnson said: “It is encouraging to see a noticeable reduction in cocaine use among young people over the last couple of years.
“Fewer young Londoners are using drugs but we can’t be complacent. Substance abuse causes widespread problems across the city.”
The Greater London Alcohol and Drug Alliance is a partnership bringing key agencies together to analyse trends and share information reducing alcohol and drug related harm in London, and is supported by the Greater London Authority.

Source: http://news.bbc.co.uk/go/pr/fr/-/1/hi/england/london/7939368.stm  2009/03

Drinking heavy amounts of alcohol over a long period of time may decrease brain volume, according to research that was presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 — May 5, 2007. The study found the more alcohol people drink on a regular basis, the lower their brain volume.
The study involved MRI scans of 1,839 people from the Framingham Offspring study, ages 34 to 88, who were classified as non-drinkers, former drinkers, low drinkers (one to seven drinks per week), moderate drinkers (eight to 14 drinks per week), or high drinkers (more than 14 drinks per week). MRI scans were performed and used to measure brain volume, which can be thought of as a measure of brain aging.
“Research has shown that there is a beneficial effect of alcohol in reducing incidence of cardiovascular disease in people who consume low to moderate amounts of alcohol. However, this study found that greater alcohol consumption was negatively correlated with brain volume,” said study author Carol Ann Paul, MS, of Wellesley College in Wellesley, MA.
This cross-sectional study found people who had more than 14 drinks per week had an average 1.6 percent reduction in the ratio of brain volume to skull size compared to people who didn’t drink. In other words, brain volume decreased .25 percent on average for every increase in drinking category (i.e. non-drinkers, former drinkers, low drinkers, moderate drinkers, or high drinkers).
In addition, Paul reported the inverse relationship between drinking and brain volume was slightly larger in women than in men. Also, drinking heavy amounts of alcohol seemed to have the biggest negative impact on brain volume for women in their 70s.
In looking at the longitudinal effects of drinking, people who had a 12-year history of heavy drinking had less brain volume than those who changed into the high drinking group during those 12 years. Researchers are following up on these findings to make sure these differences hold up.

Source: ScienceDaily (May 3, 2007)

The body of evidence linking alcohol consumption with increased cancer risk has been added to by a study recently published in Cancer Epidemiology, Biomarkers and Prevention, which found that drinking two alcoholic drinks every day can increase one’s risk of getting pancreatic cancer.

Details and Findings of Study

The study team, led by Jeanine M Genkinger, an assistant professor of oncology at the Lombardi Comprehensive Cancer Center at Georgetown University, Washington, DC, had examined the findings of 14 studies previously conducted on the subject of alcohol consumption and pancreatic cancer. The 14 studies covered a total of almost 863,000 men and women. Of the group, 2,187 persons were diagnosed with the disease.

Based on available information on the study subjects’ dietary habits, the researchers found that persons who consumed two or more alcoholic drinks per day had 22% increased risk of pancreatic cancer, as compared to those who stayed off such beverages. Here, one drink was defined by 4 ounces of wine, 12 ounces of beer or 1.5 ounces of 80-proof liquor.

Zooming in, the study team discovered that two or more drinks a day raised women’s risk by 41%, while only elevating men’s risk by 12%, the latter figure not having statistical significance. When the bar for men was raised to more than three drinks, their increased risk for a particular type of pancreatic cancer, adenocarcinoma, was found to be 60%, a figure which had become statistically significant; adenocarcinomas are the most common type of pancreatic cancer. This suggests that men have a higher tolerance for alcohol.

One interesting finding was that the effect of alcohol on pancreatic cancer was more pronounced among persons in the healthy weight range. However, before those who are overweight or obese rejoice, this, according to the researchers, is likely down to the fact that obesity is already a strong risk factor for the disease, and that could have masked the effects of alcohol on pancreatic cancer risk for the overweight subjects.

Another interesting finding was that the effects of alcohol were the same regardless of the type which was consumed.

Source:  http://www.naturalnews.com/025884.html Saturday, March 21, 2009

New evidence by researchers at the Centre for Addiction and Mental Health (CAMH) and researchers in Germany shows that drinking alcohol is the greatest risk factor for acetaldehyde-related cancer. Heavy drinkers may be at increased risk due to exposure from multiple sources.

Acetaldehyde is ubiquitous in daily life in Ontario. Widely present in the environment, it is inhaled from the air and tobacco smoke, ingested from alcohol and foods, and produced in the human body during the metabolism of alcoholic beverages. Research indicates that this organic chemical plays a significant role in the development of certain types of cancers (especially of the upper digestive tract), and it is currently classified as possibly carcinogenic by the International Agency for Research on Cancer of the World Health Organization.
New research from CAMH in Toronto and the Chemical and Veterinary Investigation Laboratory Karlsruhe (CVUA) in Germany recently provided the necessary methodology for calculating the risk for the ingestion of alcoholic beverages.
The team found that risk from ingesting acetaldehyde via alcoholic beverages alone may exceed usual safety limits for heavy drinkers. Their risk assessment study found that the average exposure to acetaldehyde from alcoholic beverages resulted in a life-time cancer risk of 7.6/10,000, with higher risk scenarios (e.g. contaminations in unrecorded alcohol) in the range of 1 in 1,000. As such, the life-time cancer risks for acetaldehyde from ingestion of alcoholic beverages greatly exceed the usual limits for cancer risks from the environment.
The research team noted, however, that this risk is compounded by the addition of acetaldehyde exposure from different sources. “The problem with acetaldehyde has been that although it has been recognized as toxic by Health Canada some years ago, most risk assessments to date were based on one source of exposure only” explained Dr. Jürgen Rehm, the lead scientist of the Toronto group and head of the Public Health and Regulatory Policies section at CAMH. “This has led to a negligence of the overall risk.”
For example, in Toronto, even though there are limits for air exposure of acetaldehyde set by the responsible Public Health agency, these limits have been surpassed in the past. Alone, the risks associated with surpassing limits of acetaldehyde from the air may not yet be alarming, but for heavy drinkers and smokers, it adds to the acetaldehyde levels already received from these sources. This overall risk then surpasses established safety limits.
“Their risk assessment of acetaldehyde present as a congener in alcoholic beverages touches the tip of the iceberg,” according to a Commentary on the CAMH/CVUA study in the journal Addiction.
Based on their study the scientists of CAMH recommend:
  That the classification of acetaldehyde with respect to cancer be re-examined, incorporating new evidence which points to an additional cancer risk to humans.
  That a further risk assessment should take into consideration all sources of exposure from this substance.
  That the risk for cancer stemming from acetaldehyde from alcoholic beverages is recognized, and necessary preventive steps are taken to reduce the acetaldehyde content in alcoholic beverages.
  That the overall level of acetaldehyde exposure be minimized to the lowest level technically possible.

Source: . Addiction, 2009; 104 (4): 533 DOI: 10.1111/j.1360-0443.2009.02516.x

There is growing evidence that people who experience facial flushing after drinking alcohol are at much higher risk of esophageal cancer from alcohol consumption than those who do not.

About a third of East Asians (Japanese, Chinese, and Koreans) show a characteristic physiological response to drinking alcohol that includes facial flushing, nausea, and an increased heart rate. This so-called “alcohol flushing response” is predominantly due to an inherited deficiency in an enzyme called aldehyde dehydrogenase 2 (ALDH2). Although clinicians and the East Asian public generally know about the alcohol flushing response, few are aware of the accumulating evidence that ALDH2-deficient individuals are at much higher risk of esophageal cancer (specifically squamous cell carcinoma) from alcohol consumption than individuals with fully active ALDH2.
Dr Philip Brooks and colleagues from the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Maryland, USA, along with Dr. Akira Yokoyama from the Kurihama Alcohol Center in Japan, say that this lack of awareness is “unfortunate as esophageal cancer is one of the deadliest cancers worldwide, with five-year survival rates of 15.6% in the United States, 12.3% in Europe, and 31.6% in Japan.”
“Our goal in writing this article,” say the researchers, “is to inform doctors firstly that their ALDH2- deficient patients have an increased risk for esophageal cancer if they drink moderate amounts of alcohol, and secondly that the alcohol flushing response is a biomarker for ALDH2 deficiency.”
Clinicians, they say, can determine ALDH2 deficiency simply by asking about previous episodes of alcohol-induced flushing.
“As a result,” say Dr Brooks and colleagues, “ALDH2-deficient patients can then be counseled to reduce alcohol consumption, and high-risk patients can be assessed for endoscopic cancer screening.”
In view of the approximately 540 million ALDH2-deficient individuals in the world, many of whom now live in Western societies, even a small percent reduction in esophageal cancers due to a reduction in alcohol drinking would translate into a substantial number of lives saved

Source:. . PLoS Medicine, 2009; 6 (3): e50 DOI: 10.1371/journal.pmed.1000050

Researchers at the Centre for Addiction and Mental Health (CAMH) have clarified the link between alcohol consumption and the risk of head and neck cancers, showing that people who stop drinking can significantly reduce their cancer risk.

According to CAMH Principal Investigator Dr. Jürgen Rehm, existing research consistently shows a relationship between alcohol consumption and an increased risk for cancer of the esophagus, larynx and oral cavity. Dr. Rehm and his team analyzed epidemiological literature from 1966 to 2006 to further investigate this association and their results, published in the September issue of the International Journal of Cancer, showed that:
  The risk of esophageal cancer nearly doubled in the first two years following alcohol cessation, a sharp increase that may be due to the fact that some people only stop drinking when they are already experiencing disease symptoms. However, risk then decreased rapidly and significantly after longer periods of abstention.
  Risk of head and neck cancer only reduced significantly after 10 years of cessation.
  After more than 20 years of alcohol cessation, the risks for both cancers were similar to those seen in people who never drank alcohol.
These results have important implications for tailoring alcohol policies and prevention strategies, especially for people with a family risk of cancer.
Said Dr. Rehm, “Alcohol cessation has very similar effects on risk for head and neck cancers as smoking cessation has on lung cancer. It takes about two decades before the risk is back to the risk of those who were never drinkers or never smokers.”
Alcohol is the ‘drug of choice’ for Canadians, with 60% of Ontario adults consuming alcohol on at least a monthly basis. The direct and indirect costs to society of alcohol abuse are substantial: $5.3 billion in Ontario alone, second only to the social burden of tobacco. This burden takes into effect the cardioprotective effects of alcohol, which, unlike its link to cancer, has received a great deal of public attention.
Dr. Rehm notes that more research is needed on the effects of alcohol cessation on other types of cancer — especially breast, liver and colorectal cancers, for which the International Agency for Research on Cancer has also classified alcohol as carcinogenic — and on the effects of alcohol type, drinking patterns, and the joint effects of smoking and alcohol cessation on the risk of cancer.

Source: Centre for Addiction and Mental Health 2007, September 28.

Cigarette smoking is more strongly associated with head and neck cancers than drinking alcohol, according to a new study. The study found that smoking is responsible for a quarter of head and neck cancers among individuals who do not drink alcohol.

At least 75 percent of head and neck cancers are caused by a combination of cigarette smoking and drinking alcohol, but researchers have not known the individual contributions of these risk factors because people who smoke are more likely to drink than the general population and vice versa. In a new study, researchers sought to tease out the independent effect of each risk factor on head and neck cancer development.
Mia Hashibe, Ph.D., of the International Agency for Cancer Research in Lyon, France, and colleagues examined head and neck cancer risk among smokers who never drank alcohol and people who drink but never used tobacco products. They pooled data from 15 case–control studies, which included 10,244 head and neck cancer patients and 15,227 controls. About 16 percent of the patients and 27 percent of the controls never drank, and about 11 percent of the patients and 38 percent of the controls never smoked.
Cigarette smoking was associated with an increased risk of head and neck cancer–especially cancer of the larynx–among patients who never drank alcohol. About 24 percent of head and neck cancers were due to smoking among patients who never drank.
Drinking alcohol was also associated with greater risk of head and neck cancers among never smokers, but mainly for patients who drank three or more drinks per day. They had twice the risk of head and neck cancers as people who never drink. Only seven percent of head and neck cancers were due to drinking among never smokers.
“The major strength of our pooled analyses was assembly of a very large series of never users of tobacco and never drinkers among head and neck cancer patients and control subjects, which allowed us to examine head and neck cancer risks in detail and to explore differences in risks by cancer subsite, geographic region, and sex,” the authors write.
 
Source:  Journal of the National Cancer Institute  2007, May 16.  99: 777-789

The number of alcohol and drug abusers being treated by mental hospitals has leapt by almost a third in five years.   Doctors have also charted a rising number of patients being sectioned because of psychiatric problems – many in private hospitals at NHS expense.
Critics last night blamed the binge drink and drug culture for creating more mental health disorders, while cuts in NHS beds are increasing dependency on the private sector.  Critics blame binge drink and drug culture for creating more mental health disorders
A report by three psychiatrists in the British Medical Journal says there is concern about an era of ‘re-institutionalisation’ within mental hospitals.
The number of hospital beds dropped from 150,000 in the 1950s to less than 55,000 in 1995 in favour of community care but demand appears to be rising, they say.   The number of sectioned patients – taken into hospital under compulsory orders – has increased by 20 per cent over the last decade.
The psychiatrists found a 29 per cent rise in admissions by alcohol and drug abusers since 2003.  They say the numbers have changed the environment on psychiatric wards with reports of patients with depression feeling intimidated and even attacked by those with drink and drug problems.
Tories claimed the increase was not being helped by Labour ‘mixed messages’ on the dangers of drugs and its rolling out of 24-hour drinking.

Source:  www.MailOnline  Oct.2008

Since states began setting the legal drinking age to 21, the National Highway Traffic Safety Administration estimates over 26,000 lives have been saved. And as one of the most studied public health laws in history, the scientific research from 46 high-quality studies all found that the 21 Law saves lives.² In addition, studies show that the 21 Law reduces causes those under the age of 21 to drink less and to continue to drink less throughout their 20s.³ Of the 5,000 total alcohol-related deaths among 18-24 year-olds, 80 percent, or 4,000, were alcohol-related traffic deaths.4
“Lowering the minimum drinking age to 18 is both misguided and dangerous,” said IACP former President Ronald Ruecker, Director of Public Safety in Sherwood, Oregon. “The worst thing any police officer has to do is knock on a door in the dead of night to tell parents that their child will not be coming home because he or she is a victim of impaired driving. Lowering the national drinking age would inevitably lead to more tragedies for more families.”
The public strongly disagrees with efforts to lower the drinking age. According to a 2008 survey by Nationwide Insurance, 78 percent of adults support 21 as the minimum drinking age and 72 percent believe lowering the drinking age would make alcohol more accessible to youth.
Bill Windsor, Associate Vice President of Safety for Nationwide, said, “While advocates argue a lower drinking age will curb teen binge drinking, our survey shows only 14 percent of Americans agree and 47 percent believe it will actually make a huge problem worse. Americans feel so strongly about teen binge drinking more than half say they are less likely to vote for a politician who supports lowering the legal limit or to send their child to a known ‘party school.’”
Parents are crucial in addressing this problem and can do more by talking and listening to their son or daughter about the many challenges they will face in college. In fact, research shows that parents should educate children before they reach middle school about the dangers of alcohol. We do not want to pass the problem on to high school principals. Parents need to ask themselves whether they want their kids to have more or less access to alcohol. When searching for the right college, parents should ask questions about the college’s policies on alcohol and what the consequences are for underage drinking while on campus. MADD strongly believes parents should be notified if their son or daughter is disciplined or arrested for alcohol.
Dean-Mooney said, “Underage drinking is not just a youth problem, but an adult problem.” Parents and other adults are the key to reducing underage drinking. MADD is developing a program for parents that will give them proven-effective tools for communicating to their teens about this issue.
Source: February 23, 2009 Mothers Against Drunk Driving (MADD)

Scientists at Melbourne’s Howard Florey Institute have discovered a system in the brain that stops an alcoholic’s craving for alcohol, as well as prevent relapse once they have recovered from alcohol addiction.

The ‘Orexin’ system is a group of cells in a part of the brain called the hypothalamus. These cells produce Orexin, which was originally implicated in the regulation of feeding, but it soon became apparent that Orexin was also involved in the ‘high’ felt after drinking alcohol or taking illicit drugs.
In studies conducted with rats, Dr Andrew Lawrence and his Florey colleagues used a drug that blocked Orexin’s euphoric effects in the brain and the results were remarkable.
“In one experiment, rats that had alcohol freely available to them stopped drinking it after receiving the Orexin blocker.” Dr Lawrence said.
“In another experiment, rats that had gone through a detox program and were then given the Orexin blocking drug, did not relapse into alcohol addiction when they were reintroduced to an environment in which they had been conditioned to associate with alcohol use.
“Orexin reinforces the euphoria felt when drinking alcohol, so if a drug can be developed to block the Orexin system in humans, we should be able to stop an alcoholic’s craving for alcohol, as well as preventing relapse once the alcoholic has recovered,” he said.
Dr Lawrence said that this research could also lead to treatments for eating disorders, such chronic over-eating, which leads to obesity.
“Our research shows that alcohol addiction and eating disorders set off common triggers in the brain, so further investigations may uncover drug targets in the Orexin system to treat both conditions,” Dr Lawrence said.
The Florey scientists are now conducting multiple experiments to discover the precise circumstances that activate the Orexin system.
“To explore this discovery further we are now investigating how different experimental paradigms and environmental situations impact on the Orexin system, which will hopefully pinpoint therapeutic drug targets,” Dr Lawrence said.
“Before a therapeutic Orexin-blocking drug can be developed, we need to ensure that it will be safe to use in the long-term and that issues surrounding a person’s compliance in taking the drug are considered,” he said.
According to the World Health Organisation, alcohol is one of the most widely used and abused substances in the world and causes as much, if not more death and disability as measles, malaria, tobacco, or illegal drugs.
Dr Lawrence and his colleagues were the first in the world to demonstrate the Orexin system’s involvement in alcohol addiction and their research paper was recently published in the prestigious British Journal of Pharmacology. Dr Lawrence’s paper was downloaded 658 times by researchers from around the world in the first three months of its publication, making it the most downloaded research paper in that issue and supporting the research’s importance.
The Howard Florey Institute is Australia’s leading brain research centre. Its scientists undertake clinical and applied research that can be developed into treatments to combat brain disorders, and new medical practices. Their discoveries will improve the lives of those directly, and indirectly, affected by brain and mind disorders in Australia, and around the world. The Florey’s research areas cover a variety of brain and mind disorders including Parkinson’s disease, stroke, motor neuron disease, addiction, epilepsy, multiple sclerosis, autism and dementia.

Source: Howard Florey Institute (2006, December 13). Research Offers Hope For Alcoholics. ScienceDaily. Retrieved May 31, 2009, from http://www.sciencedaily.com¬ /releases/2006/12/061212213910.htm

Alcohol-dependent patients who received the medication topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received placebo, according to a study in the October 10 issue of JAMA.

According to background information in the article, a previous, shorter trial indicated that topiramate, a medication used in the treatment of seizures, may be beneficial for the treatment of alcohol dependence.
Bankole A. Johnson, D.Sc., M.D., Ph.D., of the University of Virginia, Charlottesville, Va., and colleagues conducted a multisite, 14-week, randomized controlled trial to determine the efficacy of topiramate compared with placebo. The study, which included 371 men and women age 18 to 65 years diagnosed with alcohol dependence, was conducted between January 2004 and August 2006 at 17 U.S. sites. The participants received up to 300 mg/day of topiramate (n = 183) or placebo (n = 188), along with a weekly psychosocial treatment to promote adherence with the study medication and the treatment regimen.
Treating all dropouts as relapse to baseline, topiramate compared with placebo recipients showed greater reduction of percentage of heavy drinking days from baseline to week 14 (from an average of 81.9 percent to 43.8 percent for topiramate vs. 82.0 percent to 51.8 percent for placebo; average difference, 8.44 percent). Prespecified analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (average difference, 16.19 percent).
The researchers also found that topiramate compared with placebo treatment was associated with a significantly higher rate of achieving 28 or more days of continuous nonheavy drinking and 28 or more days of continuous abstinence. Adverse events that were more common with topiramate vs. placebo included paresthesia (abnormal skin sensations), taste perversion, anorexia, and difficulty with concentration.
“Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the U.S. and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings,” the authors conclude.
Article Reference: JAMA. 2007;298(14):1641-1651
Editorial: Medications to Treat Alcohol Dependence
In an accompanying editorial, Mark L. Willenbring, M.D., of the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Md., writes that alcohol dependence is a disease that needs greater attention in the health care community.
“Alcohol dependence is the third leading modifiable cause of death in the United States, accounting for about 85,000 deaths per year. Reducing incidence, shortening the course, and reducing the severity of episodes are valuable and important goals. Reducing the public health burden will involve addressing the needs of a broader range of patients than can be treated by the specialty treatment system. In particular, it will be important to reduce disability caused by currently untreated episodes of dependence among those with the nonrelapsing form of the illness.”
“By historical standards, the pace of medication development for treating this disorder is increasing, and a variety of medications with different modes of action are now available. A solid understanding of the neurobiology of alcohol addiction is providing the framework for multiple avenues of further medication development. The behavioral platform required to support medication treatment is similar to that for depression, attention-deficit/hyperactivity disorder, diabetes, and other chronic illnesses, and thus could potentially fit into general medical practice.”
Source: JAMA and Archives Journals (2007, October 10). Medication Shows Promise As A Treatment For Alcohol Dependence. ScienceDaily. Retrieved May 31, 2009

Alcoholics who smoke appear to lose more brain mass than alcoholics who don’t smoke, according to a study at the San Francisco VA Medical Center.

It is already well-known that the brains of long-term alcoholics atrophy and shrink, the study authors say, but the new findings are the first evidence that cigarette smoking might contribute to that atrophy, particularly in grey matter of the parietal and temporal lobes.
Fifty to 90 percent of alcoholics also are smokers, according to Dieter Meyerhoff, PhD, a radiology researcher at SFVAMC and the principal investigator of the study
“Just looking at the amount of tissue mass lost due to either drinking or smoking, alcoholics who smoke show a greater loss in some regions of the brain compared to alcoholics who don’t smoke,” says Meyerhoff, who also is a professor of radiology at the University of California, San Francisco.
The study, which was published in the August 2005 issue of Alcoholism: Clinical and Experimental Research, compared 37 recovering alcoholics between the ages of 26 and 66 with a control group of 30 healthy light drinkers. The researchers used magnetic resonance imaging, a safe, non-invasive imaging technique, to measure brain volumes of the study participants.
They discovered that the more severe the tobacco habit, the greater the brain injury. “In smoking alcohol-dependent individuals, smaller regional [brain] volumes are related to greater cigarette-smoking severity,” according to the study findings, with severity measured by level of nicotine dependence, cigarettes smoked per day, and years of smoking.
The alcoholics (24 smokers and 13 non-smokers) averaged around 400 drinks per month for three years prior to the study; the light drinkers (seven smokers and 23 non-smokers) averaged between four and 11 drinks per month before the study and had no history of alcohol abuse or dependence. The alcoholics were sober for approximately one week before the study began.
The study uncovered no apparent differences in brain volume between smoking and non-smoking light drinkers.
Another key finding was that among non-smoking alcoholics, there was a direct relationship between brain volume and cognitive function: the higher the volume, the better the function. However, no such relationship was apparent among smoking alcoholics, according to co-author Timothy Durazzo, PhD, an associate radiology researcher at SFVAMC. Nor has such a relationship been measured before in previous studies on alcohol abuse and brain volume, he says.
“And this makes us wonder if what has been reported in the literature of alcoholism could have been obscured or distorted by combining smokers and non-smokers in the same studies,” Durazzo adds.
In their paper, the researchers speculate that smoking “disrupts these [brain] structure-function relationships,” possibly through its detrimental effects on brain volume or on brain neurochemistry.
Meyerhoff and his co-authors emphasize that their results are retrospective — that is, they discovered the apparent effects of smoking during statistical analysis of the participants in an earlier study they conducted on alcoholism and its effects on the brain. They then went back, re-classified each study participant as smoking or non-smoking, and analyzed brain volumes accordingly.
The authors say that if replicated in other studies, their results will raise several potentially important questions. The first is whether recovering alcoholics should also be treated for smoking — and if so, at what point during their treatment. At present, alcohol treatment programs such as Alcoholics Anonymous do not discourage smoking or even address the issue, they say.
Beyond that, says Durazzo, there is the potential effect of smoking on cognitive dysfunction, which is common among older long-term alcoholics. “Right now, our study participants are relatively young, around 50,” he notes. “But will the combination of smoking and drinking, or continued smoking during abstinence from alcohol, put them at greater risk for cognitive dysfunction as they age?” Finally, says Meyerhoff, there is the question of whether smoking has an effect on physical recovery from alcohol abuse. “In alcoholics who stop drinking, we know that there is recovery from at least some of these injuries to the brain — but is this recovery affected by continued smoking?” Meyerhoff and his team are conducting a study to explore that question right now.
In the future, the researchers plan a prospective study that will use MRI to compare brain volumes between smoking and non-smoking light drinkers and smoking and non-smoking alcoholics, with the hope of replicating the results of their current retrospective study.

Source: University of California – San Francisco (2005, September 29). Smoking Seems To Increase Brain Damage In Alcoholics. ScienceDaily. Retrieved May 31, 2009, from http://www.sciencedaily.com¬ /releases/2005/09/050929081514.htm

Far more babies may be damaged in the womb as a result of their mother’s drinking habits than was assumed, the British Medical Association warned today as it backed the government’s call for pregnant women and those trying for a baby to give up alcohol completely.
Only babies with full-blown foetal alcohol syndrome tend to be diagnosed and counted by doctors in the UK. But a BMA report published today called for data to be collected on a much wider and sometimes less obvious category of damage, called foetal alcohol spectrum disorders.
Around 0.2 per 1,000 UK babies suffer from foetal alcohol syndrome, which impairs the brain, causes abnormal facial features and leads to low birth weight. However, the wider foetal alcohol spectrum disorders were found to affect around 10 per 1,000 babies in Canada, one of the few countries to collect statistics on the latter category.
“We want to make it clear that people should be more prepared to make the diagnosis, not just of foetal alcohol syndrome but of the whole spectrum of disorders,” said Vivienne Nathanson, head of science and ethics at the BMA.
“There is good evidence that it is being under-diagnosed in the UK because there isn’t a specific test.”
Babies born with the spectrum of disorders have some but not all of the problems that foetal alcohol syndrome brings. They may suffer from hyperactivity, be unable to concentrate, have a short attention span, or be slow to develop.
The BMA notes that there is still controversy in the UK about the existence even of foetal alcohol syndrome, which may explain, the report says, why data on the spectrum of disorders is not collected.
But, said Dr Nathanson, “it is so important that the discussions need to go on in parallel with getting women into treatment.”
The BMA recognises that there is no evidence that a low level of drinking – one to two units a week – harmed the unborn child. But, said Dr Nathanson, “the fact that we haven’t yet got the evidence doesn’t mean that there isn’t evidence of a link. It may be that it is just very difficult to get.”
It has been shown that alcohol reaches the foetus across the placental barrier, and also that low levels of exposure to alcohol have an effect in animals.
Women who are thinking of having a baby should not drink because significant damage can be done in the weeks before a woman knows she is pregnant. “I have a couple of patients whose mothers were binge drinking heavily at the weekends before they knew they were pregnant, and they have full foetal alcohol syndrome,” said Dr Raja Mukherjee, a consultant psychiatrist for people with learning disabilities at the Surrey and Border Partnership Trust.
The BMA report, titled Fetal Alcohol Spectrum Disorders, says it is very difficult for anybody to know how many units of alcohol they are drinking. Bottles of wine have risen from 8% to 12% proof and measures of wine and spirits vary considerably in pubs and restaurants. The BMA is calling for all bottles of alcohol and pub and restaurant drinks to be labelled with the number of units they contain.
Source: guardian.co.uk, Monday 4 June 2007

A UK study based on a cohort of more than 1 million
women related baseline alcohol intake to the relative risk
(RR) of incident invasive cancer at 21 sites. A quarter of
the cohort reported drinking no alcohol; 98% of those who
drank consumed fewer than 21 drinks per week and had an
average consumption of 10 g of alcohol per day (1 standard
drink as defined in this study). Only current drinkers were
included in dose-response analyses; both lifetime abstainers
and ex-drinkers were excluded. During an average of 7.2
years of follow-up, 68,775 invasive cancers occurred. Results
included the following:
• Increased alcohol consumption was associated with
increased risk of cancers of the oral cavity and pharynx
(increase in RR per 10 g daily increase in alcohol intake,
29%), esophagus (22%), larynx (44%), rectum
(10%), liver (24%), breast (12%), and total cancer (6%).
• For cancers of the upper aerodigestive tract, alcoholassociated
risk was confined to current smokers, with
little or no effect among never or past smokers.
• Increased alcohol consumption was associated with a
decreased risk of thyroid cancer, non-Hodgkin lymphoma,
and renal cell carcinoma.
• Trends were similar in women who drank wine exclusively
compared with consumers of other types of alcohol.
• For every additional drink regularly consumed per day,
the increase in incidence up to age 75 years per 1000

women in developed countries was estimated to be
about 11 for breast cancer; 1 for cancers of the oral
cavity and pharynx; 1 for cancer of the rectum; and 0.7
each for cancers of the esophagus, larynx, and liver.
Comments: The results of this study support what has been
known for many decades: there is an association between
alcohol intake, especially heavy intake, and upper aerodigestive
cancers. Further, even moderate drinking may increase
the risk of other cancers, including breast cancer.
There are, however, a number of analytic problems with
this paper: the authors were unable to compare results of
current drinkers with lifetime abstainers and ex-drinkers
separately; no data were provided on pattern of drinking
(regular or binge); and only linear analysis was used, making
it difficult to judge if the association between alcohol
and these cancers was U-shaped, J-shaped, or showed a
threshold effect. While it is important to emphasize that
alcohol can be associated with cancer, it will be especially
important for additional studies based on this large cohort
to report the net effects of drinking on other diseases and
on total mortality.

Source: Allen NE, Beral V, Casabonne D, et al. Moderate
alcohol intake and cancer incidence in women. J Natl Cancer
Inst. 2009;101(5):296–305.

Researchers studying fruit flies have discovered a gene that raises tolerance for alcohol and could be the basis for gene therapy for alcoholism, ABC News reported May 23.
The study found that when the gene — dubbed “happyhour” by researchers — was switched off by blocking its action with an anticancer drug called Tarceva, the flies became more sensitive to alcohol and drank less. The drug, like the gene, acts on a cellular network called the EGF pathway.
“People who are very sensitive to alcohol tend to drink less — that’s the person who gets drunk on one glass of wine,” noted Brown University psychiatrist Robert Swift. “The person who can drink everybody under the table — that’s that person who is more likely to become an alcoholic.”
Researcher Ulrike Heberlein of the University of California at San Francisco and colleagues found the gene by studying mutant fruit flies that could outdrink other flies. In past studies, Heberlein’s team discovered a gene called “cheapdate” that makes flies highly sensitive to alcohol.
“I’m very much looking forward for [Tarceva] to be tested in humans, and it’s quite possible one wouldn’t need the doses used in chemotherapy to treat addicts,” said Heberlein.
Source: journal Cell. May 21, 2009

New research suggests that individuals who begin drinking alcohol as teenagers are more likely than those who start drinking after age 21 to suffer alcohol-related harm as adults.
Reuters reported June 5 that researchers Ralph Hingson and Wenxing Zha from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that adults who began drinking at age 16 or younger drove drunk, suffered unintentional injuries, and became dependent on alcohol at about twice the rate as those whose onset of drinking occurred at age 21 years or older.
Source: Pediatrics. May 26, 2009

Research Summary
Drivers ages 21 to 34 comprise a disproportionate share of fatal motor vehicle crashes in which at least one of the drivers was legally intoxicated (had a BAC of .08 or greater), according to data from the National Highway Traffic Safety Administration (NHTSA).
Although drivers ages 21 to 34 were involved in 31% of all fatal crashes in 2006, they were involved in 43% of all fatal crashes in which at least one driver was intoxicated.
On the other hand, drivers ages 45 or older were involved in 36% of all fatal crashes, but just 23% of drunk-driving fatal crashes.
These findings suggest that prevention efforts may be most effective if they focus on educating young adult drivers about the dangers of driving while intoxicated.
Source: , from The Center on Substance Abuse Research (CESAR) at the University of Maryland. October 1, 2007

A new global study has found that lifestyle risk factors such as alcohol consumption and cigarette smoking are important risk factors for bowel cancer. Researchers have shown that people who consume the largest quantities of alcohol (equivalent to > 7 drinks per week) have 60% greater risk of developing the cancer, compared with non-drinkers.

Smoking, obesity and diabetes were also associated with a 20% greater risk of developing bowel cancer – the same risk linked with consuming high intakes of red and processed meat.
Approximately one million new cases of bowel (colorectal) cancer are diagnosed worldwide each year, and more than half a million people die from this type of cancer. In Australia alone, it is the most commonly occurring cancer with more than 12,000 new cases diagnosed each year.
According to lead researcher Associate Professor Rachel Huxley at The George Institute, the most startling finding of this study was, “The strong, and largely, unknown association between high intakes of alcoholic beverages with risk of colorectal cancer. Most people probably know that being overweight and having poor dietary habits are risk factors for the disease, but most are probably unaware that other lifestyle risk factors such as alcohol consumption, cigarette smoking and diabetes are also important culprits.”
Australia’s National Health and Medical Research Council recommend individuals shouldn’t be drinking more than two standard drinks per day.
On a positive note, researchers also demonstrated that physical activity lowered an individual’s risk of the disease but surprisingly, there was little evidence to indicate that high intakes of fruit and vegetables were protective against bowel cancer.
“These findings strongly suggest that a large proportion of colorectal cancer cases could potentially be avoided by making relatively modest lifestyle adjustments such as drinking less, quitting smoking, eating healthily and being a little more active”, said Associate Professor Huxley. “Such changes would also have huge benefits in terms of reducing an individuals’ risk of developing other major forms of illness including cardiovascular disease.”
The study reviewed more than 100 published studies that had reported on the association between major and modifiable risk factors for colorectal cancer including alcohol, smoking, diabetes, physical activity and various dietary components.

Source: Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.

Abstract
Background Although moderate alcohol consumption has been shown to confer a protective effect for specific diseases, current societal patterns of alcohol use impose a huge health and economic burden on modern society. This study presents a method for estimating the health and economic burden of alcohol consumption to the UK National Health Service (NHS).
Methods Previous estimates of NHS costs attributable to alcohol consumption were identified by systematic literature review. The mortality and morbidity due to alcohol consumption was calculated using information from the World Health Organization Global Burden of Disease Project and routinely collected mortality data. Direct health-care costs were derived using information on population attributable fractions for conditions related to alcohol consumption and NHS cost data.
Results We estimate that alcohol consumption was responsible for 31 000 deaths in the UK in 2005 and that alcohol consumption cost the UK NHS £3.0 billion in 2005–06. Alcohol consumption was responsible for 10% of all disability adjusted life years in 2002 (male: 15%; female: 4%) in the UK.
Conclusions Alcohol consumption is a considerable public health burden in the UK. The comparison of the health and economic burden of various lifestyle factors is essential in prioritizing and resourcing public health action
Source: Journal of Public Health Advance Access published online on June 3, 2009

New research suggests that the combination of drinking alcohol and smoking cigarettes increases the risk of throat and stomach cancers.
Researchers investigated risk factors for three kinds of cancers: esophageal adenocarcinoma (throat cancer), gastric cardia adenocarcinoma (stomach cancer) and esophageal squamous cell carcinoma (which resembles head and neck cancer).
Past studies have linked cancer of the esophagus to drinking and smoking, but the new research found that people who drank four glasses of alcohol daily had five times the risk of developing esophageal squamous cell carcinoma than nondrinkers. Smoking was related to increased risk of developing all three types of cancer, with risk of throat cancer the most elevated.
“It appeared that current smokers have the highest risks, and former smokers have an intermediate risk compared with never-smokers,” said study author Jessie Steevens, an epidemiologist at Maastricht University in the Netherlands.
The findings were presented at a meeting of the American Association for Cancer Research.
Source: Reuters November 17, 2008

New research suggests a relationship between alcohol use and increased risk of recurring breast cancer.
Previous studies had determined that women with a history of cancer in one breast have increased risk of developing cancer in the second breast, but the new findings suggest “a 30-percent higher risk in those who (ever) drank alcohol compared to those who did not,” said Julia Knight, co-author of the study.
Researchers from Mount Sinai Hospital in Toronto compared drinking patterns and cigarette smoking among women with a history of cancer in one breast who had (708 women) or had not (1,399 women) developed cancer in their second breast.
They found no significant increased risk associated with cigarette smoking, but regular alcohol consumption resulted in elevated risk of developing cancer in the second breast. A longer duration of alcohol consumption appeared to increase risk for a second occurrence of breast cancer, as well.
While calling for further investigations to increase knowledge of how drinking patterns affect risk, Knight said that “based on what we know now …. it is better for women to avoid drinking a lot in general.”
Source: American Journal of Epidemiology. February 2009

Research Summary
Researchers at Heidelberg University in Germany have found that it takes only six minutes for a change in brain cells to occur after drinking the equivalent of about three glasses of beer or two glasses of wine, Science Daily reported June 15.
Researchers gave 15 healthy subjects (eight male and seven female) enough alcohol to produce a blood alcohol level of 0.05 to 0.06 percent — sufficient to impair driving but not severe intoxication.
Using magnetic resonance spectroscopy (MRS), the researchers found that the concentration of creatine, a substance that protects brain cells, decreased as the amount of alcohol increased. Chloine, a component of cell membranes, was also reduced. Lead author Armin Biller of Heidelberg’s Department of Neuroradiology said that the reduction in chloine probably indicated that alcohol triggered changes in the composition of cell membranes.
The researchers also found that the day after the subjects had consumed alcohol, their brain metabolism had reverted to what it had been prior to the experiment. However, Armin warned that, “The brain’s ability to recover from the effect of alcohol decreases or is eliminated as the consumption of alcohol increases. The acute effects demonstrated in our study could possibly form the basis for the permanent brain damage that is known to occur in alcoholics. This should be clarified in future studies.”
The study found no differences between male and female subjects, suggesting that the brains of female and male subjects reacted to alcohol consumption the same way.
Source: Journal of Cerebral Blood Flow & Metabolism. June 22, 2009

Research Summary
A Penn State researcher says that parents who let teens drink alcohol may be setting their kids up for binge drinking in college, but the study by Caitlin Abar of the school’s Prevention Research and Methodology Center makes no distinction between parents who simply let kids drink some wine during meals and those whose permissiveness extends to drinking outside the home.
Science Daily reported June 11 that Abar surveyed 300 college freshmen and correlated their alcohol use to the drinking rules set down by their parents. Abar found that students whose parents never allowed them to drink were less likely to report heavy drinking in college.
On the other hand, “the greater number of drinks that a parent had set as a limit for the teens, the more often they drank and got drunk in college,” said Abar.
Abar said the research argues in favor of “zero tolerance” for teen drinking and against the theory that parental restrictions on drinking casts alcohol as attractive “forbidden fruit” and leads to greater temptation to drink in college. Whether or not parents themselves drank had little impact on college binge drinking, Abar added.
Thirty-one states allow parents to legally serve alcohol to children under age 21.
The research was presented at the recent and.
Source: annual meeting of the Society for Prevention Research ,to be published in the journal Addictive Behaviors June 24, 2009

Sipping wine, beer or spirits three to four times per week increases the risk of binge drinking, particularly among young men, according to a new study published in the journal Addiction. Researchers from the Université de Montréal and the University of Western Ontario analyzed the drinking habits of Canadians and found that frequent alcohol consumption can lead to binge drinking among all gender and all age groups.The study also found that infrequent drinkers rarely exceed two servings when they do consume alcoholic beverages. “The relationship between drinking frequency and consumption per occasion might be both cultural and biological,” says study coauthor Andrée Demers, a Université de Montréal sociology professor and director of the Research Group on the Social Aspects of Health and Prevention. “The Canadian drinking culture has a ‘time-out’ depiction of drinking. Alcohol is a boundary mark between week and weekend, work and leisure, and therefore between routine and time off.”
The investigation established one drink as 5 oz. of wine, 1.5 oz. of liquor, 12 oz. of beer or cooler, 3 oz of port, sherry or vermouth. Regardless of drinking preferences, the study found that many Canadians consume alcoholic beverages on a daily basis to experience its mood-altering affects.

Drinking for a festive feeling
“Regular drinking builds up tolerance, therefore daily drinkers will need more than their usual drink or two to make a difference with everyday life and gain that festive feeling,” says lead author Catherine Paradis, a Université de Montréal PhD candidate. “That fosters drinking beyond healthy limits – at least sporadically and perhaps weekly – to five drinks or more per occasion. And five units is above the recommended limits of healthy drinking.”
Study data was obtained from the GENACIS Canada project, an international collaboration examining how social and cultural variations can influence the drinking habits of men and women. Close to 11,000 respondents – 5,743 women and 4,723 men – were asked to report on their alcohol consumption within the last 12 months. Participants were asked questions such as:
“How often did you usually have any kind of drink containing alcohol?”
“How often did you usually have five drinks or more on one occasion?”
According to health-related organizations in Canada and elsewhere, women should never consume more than four drinks per occasion and alcohol is beneficial only when consumed in small quantities. Very little is known concerning the relationship between drinking frequency and risky drinking patterns.
“There is no clear and universal understanding of what is moderate drinking – its meaning varies between cultures and within cultures according to gender, age, socio-economic status and people’s self-reported tolerance,” says Professor Paradis. “Since regular drinking could increase alcohol abuse, Canadian drinking guidelines should take this aspect of the drinking pattern into account.”
Source: University of Montreal (2009, May 29). Daily Alcohol Intake Can Lead To Binge Drinking. ScienceDaily. Retrieved July 5, 2009, from http://www.sciencedaily.com¬ /releases/2009/05/090528110631.htm

Alcohol’s inebriating effects are familiar to everyone. But the molecular details of alcohol’s impact on brain activity remain a mystery. A new study by researchers at the Salk Institute for Biological Studies brings us closer to understanding how alcohol alters the way brain cells work.Their findings, published in the current advance online edition of Nature Neuroscience, reveal an alcohol trigger site located physically within an ion channel protein; their results could lead to the development of novel treatments for alcoholism, drug addiction, and epilepsy.
Ethanol, the alcohol in intoxicating beverages, is known to alter the communication between brain cells. “There’s been a lot of interest in the field to find out how alcohol acts in the brain,” says Paul A. Slesinger, Ph.D., an associate professor in the Peptide Biology Laboratory at the Salk Institute, who led the study. “One of several views held that ethanol works by interacting directly with ion channel proteins, but there were no studies that visualized the site of association.”
Slesinger and his team now show that alcohols directly interact with a specific nook contained within a channel protein. This ion channel plays a key role in several brain functions associated with drugs of abuse and seizures.
Previous research by Slesinger and his group focused on the neural function of these ion channels, called GIRK channels. GIRK channels, short for G-protein-activated inwardly rectifying potassium channels, open up during periods of chemical communication between neurons and dampen the signal, creating the equivalent of a short circuit.
“When GIRKs open in response to neurotransmitter activation, potassium ions leak out of the neuron, decreasing neuronal activity,” says UCSD Biology graduate student and first author Prafulla Aryal. Alcohols had been previously shown to open up GIRK channels but it was not known whether this was a direct effect or whether this was the by-product of other molecular changes in the cell.
Having the location of a physical alcohol-binding site important for GIRK channel activation could point to new strategies for treating related brain diseases. Using this protein structure, it may be possible to develop a drug that antagonizes the actions of alcohol for the treatment of alcohol dependence. Alternatively, “If we could find a novel drug that fits the alcohol-binding site and then activate GIRK channels, this would dampen overall neuronal excitability in the brain and perhaps provide a new tool for treating epilepsy,” says Slesinger.
Epilepsy is a neurological disease characterized by episodic, abnormal electrical activity that affects more than 3 million Americans. Current medications have serious side effects and the search for new, specific mechanisms of treatment is an area of intense research across the globe.
To gain more insight into how alcohols work, Slesinger and Aryal teamed up with Salk colleagues Senyon Choe, Ph.D., a professor in the Structural Biology Laboratory, and Hay Dvir, Ph.D., a postdoctoral researcher in Choe’s lab, to determine whether tiny pockets found in a high resolution, three-dimensional structure of a potassium channel were, in fact, the sites of alcohol action in GIRK channels. The Salk researchers noted the similarity of these candidate alcohol-binding sites with alcohol pockets visualized in two other alcohol-binding proteins: alcohol dehydrogenase, the enzyme that breaks down alcohol in the body, and a fruit fly protein, LUSH, that senses alcohol in the environment.
When Aryal systematically introduced amino acid substitutions that denied alcohol molecules access to the potential alcohol binding site, alcohol could no longer efficiently activate the channel, confirming that they had hit upon an important regulatory site for alcohol. The team further established that this pocket is a trigger point for channel activation since G protein activation was also altered. “We believe alcohol hijacks the intrinsic activation mechanism of GIRK channels and stabilizes the opening of the channel,” says Aryal. “Alcohol may accomplish this by lubricating the activation gears of the channel,” adds Slesinger.

Source: ScienceDaily. Retrieved July 5, 2009, from http://www.sciencedaily.com¬ /releases/2009/06/090628171951.htm

Researchers at the University of Toronto’s Centre for Addiction and Mental Health (CAMH) have found that the proportion of alcohol-related deaths has increased since 2000 by 0.6 percent, with 3.8 percent of all global deaths in 2004 related to alcohol use — an increase that the researchers attributed mainly to the number of women now drinking.
The researchers also found that the deaths attributable to alcohol varied regionally. Europe had the highest proportion, with 1 in 10 deaths directly attributable to alcohol (including up to 15 percent in the former Soviet Union), while the eastern Mediterranean region had the fewest alcohol-related deaths, with a rate of 1.1 per 10,000 population.
The study authors looked at diseases or disorders that are either wholly attributable to alcohol, such as alcoholic liver disease, or where alcohol is a contributory cause, such as various cancers, heart disease, and stroke. The latter category also included accidents, injuries, falls, and drownings. Taken together, these diseases and disorders constitute the burden of disease attributable to alcohol.
The researchers found that globally, 7.6 percent of men were afflicted by diseases or disorders attributable to alcohol, as were 1.4 percent of women. The study said that younger people (ages 15-59) bore the higher proportion of the disease burden — 10 percent for men and 2-3 percent for women. As with alcohol-related deaths, there was considerable geographic variation: Europe had the highest disease burden — 11 percent — and the eastern Mediterranean the lowest at 0.3 percent.
Patterns of consumption reflected mortality and the burden of disease. In Europe, consumption in the adult population was three standard drinks per person per week (1 standard drink = 13.6 grams of pure ethanol and corresponds to a can of beer, one glass or wine and one shot of spirits), compared to North America’s 10 to 11 standard drinks. Worldwide, the average is around 7 standard drinks per person per week (despite the fact that most of the adult population worldwide actually abstains from drinking alcohol).
The researchers pointed out that the economic burden of alcohol use to countries was also considerable, ranging from $358 per capita in Scotland to $837 per capita in the U.S. All countries spent more than 1 percent of their Gross Domestic Product (GDP) on dealing with the consequences of alcohol consumption. The highest expenditure among the high-income countries was the U.S., at 2.7 percent of GDP.
The world is faced with an increasing burden of disease attributable to alcohol, but lead author Juen Rehm noted, “We know more than ever about which strategies can effectively and cost-effectively control alcohol-related harms.”
Source June 2009 issue of The Lancet.

Alcohol-related deaths among women in England have nearly doubled in the past 15 years as drinking rates also have risen, according to a new government report.
Reuters reported that the U.K. had one of the lowest female alcohol death rates in Europe during the 1970s, but now about 14 of 100,000 women ages 35-54 die from alcohol-related problems.
“Whilst the EU-15 average has been falling, premature death rates from chronic liver disease and cirrhosis in females in England has risen persistently,” said the report.
“To make a difference and turn the tide of rising health harm, particularly in women, we are going to need to see some action on price, promotions, availability and advertising,” said Ian Gilmore, president of the Royal College of Physicians. “Alcohol is our favorite drug. It is around 24 hours a day and we need to examine the regulatory framework around it if we are to make any real impact.”
Source:, Health Profile of England Oct 2007

A study of 6,000 men ages 35 to 64 found that the more alcohol the men drank, the more time they spent in the hospital, Forbes reported July 1.
The Scottish study, which began in the early 1970s, divided the men into six groups: no alcohol use; 1 to 7 units consumed per week; 8 to 14 units a week; 15 to 21 units a week; 22 to 34 units a week; and 35 or more units a week or more. The researchers defined a unit of alcohol as a half-pint of beer or a 4-ounce glass of wine.
The researchers found that men who drank more than 22 units of alcohol a week had a 20-percent higher hospital-admission rate than non-drinkers, while the heaviest drinkers stayed 58 percent longer in the hospital than non-drinkers. Even relatively low levels of alcohol consumption were associated with longer hospitals stays, with the length of stay increasing as consumption did, the researchers found.
The study also found that the men who drank 15 units of alcohol a week had increased numbers of hospital admissions for stroke, and that these admissions also increased the more the men drank.
The researchers found that the men who drank 22 or more units a week had more hospital admissions for respiratory illness, but they also had the lowest admission rates for coronary heart disease, while the non-drinkers had the highest rates of admission for coronary heart disease.
Men who drank 22 or more units per week had more admissions for mental-health problems, researchers found, but non-drinkers had higher rates of admissions for mental-health problems than those who drank 1 to 14 units of alcohol a week.
The study was published online in the Journal of Epidemiology and Community Health. July 2009

Men diagnosed with cancer are less likely to survive the disease if they were smokers or heavy drinkers, Reuters reported Nov. 7.
Smoking and drinking are well-known risk factors for cancer, but researchers have begun looking into how these addictions affect survivability, as well. Researcher Young Ho Yun and colleagues at the National Cancer Center in Goyang, South Korea tracked 14,578 cancer patients for about nine years and compared mortality data to patients’ history of smoking and alcohol use.
The researchers found that former smokers were more likely to die from any kind of cancer than non-smoking cancer patients, possibly because smoking causes tumors to grow more aggressively. Smokers also may be less likely to get cancer screening tests, the authors noted, so their disease is often further advanced when treatment begins.
Among patients with head, neck, or liver cancer, heavy drinkers were more likely to die than non-drinkers, with risk increasing with consumption levels.
“Our findings suggest that groups at high risk of cancer need to be educated continually to improve their health behaviors — not only to prevent cancer, but also to improve prognosis,” the study authors noted.
The research appears in the Nov. 1, 2006 issue of the Journal of Clinical Oncology.

Children with fetal alcohol spectrum disorders (FASD) have a high risk of psychiatric problems, particularly attention deficit hyperactivity disorder (ADHD), conduct disorder, or both. Often children with FASD are initially diagnosed with ADHD. A new study is the first to examine a range of cognitive factors and social behavior in children with FASD and ADHD, finding that those with FASD have significantly weaker social cognition and facial emotion-processing abilities.

Results will be published in the October issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Behaviorally, FASD and ADHD can look quite similar, particularly with respect to problems with very limited attention, physical restlessness, and extreme impulsivity,” explained Rachel Greenbaum, a clinical psychologist with the Children’s Mental Health Team at Surrey Place Centre in Toronto, who conducted the study as part of her doctoral dissertation.

“However, social deficits in children with neurodevelopmental disorders may have different underlying mechanisms,” noted Piyadasa W. Kodituwakku, associate professor of pediatrics and neurosciences at the University of New Mexico School of Medicine. “For example, children with ADHD experience social problems because of poor self-regulation rather than deficient knowledge of appropriate social behavior. In other words, a child with ADHD may accurately recite social rules, but fail to apply them. In contrast, social difficulties in a child with autism may result from a fundamental deficit in social sense, referred to as mind-blindness. Thus, when delineating qualitative differences in social phenotypes of neurodevelopmental disorders, it is important to assess not only observable behaviors, but also their underlying cognitive mechanisms.”

This study looked specifically at social-cognition and emotion-processing abilities, said Joanne Rovet, a professor at the University of Toronto and senior scientist in neurosciences and mental health at the Hospital for Sick Children, and supervisor of the fetal alcohol research program.

“‘Social cognition’ refers to the ability to consider and differentiate between the beliefs, thoughts, feelings, and intentions of oneself and others,” said Rovet, who is also the study’s corresponding author. “This involves understanding the meaning of social information and knowing how to interact appropriately. These abilities are important for communicating and relating successfully with others. ‘Emotion processing’ refers to understanding and processing information related to feelings. This includes the ability to recognize and differentiate between varied emotions in others and in oneself. These skills are also important for relating and communicating socially with other people.”

Greenbaum and her colleagues recruited three groups of children – 33 (16 boys, 17 girls) with FASD, 30 (24 boys, 6 girls) with ADHD, and a “normal” control group of 34 (18 boys, 16 girls) – from a pre-existing data pool, clinics, communities, and schools in the greater Toronto area. The mean age was 9.2, 9.3 and 8.9 years, respectively. All completed tasks were designed to measure social cognition and emotion processing. Additionally, parents and teachers used standard questionnaires and scales to assess the children’s behavioral problems and social skills.

“Our findings show that … overall, children with FASD have more severe behavioral problems,” said Rovet. “In terms of social cognition and emotional processing, the core deficit in FASD appears to be in understanding and interpreting another’s mental states and emotions.”

Rovet added that a “profile” of children with FASD would include items such as high distractibility and restlessness, as well as behaviors often described as “out of control” and juvenile. “Based on previous work from our lab, children and adolescents with FASD were more likely than children with ADHD to engage in antisocial behaviors, such as cheating, stealing and acting young, as well as sociopathic behaviors including lying and stealing,” she said. “Importantly, the findings from our present study, specifically the significant differences in social cognition and emotional processing between children with FASD and ADHD, may underlie the severe conduct problems observed in children prenatally exposed to alcohol.”

“In other words,” said Kodituwakku, “children with FASD and ADHD have social difficulties, but what is contributing to these difficulties may be different. For example, a child with ADHD may be able to predict how another child would feel in a certain situation, but he or she may do something to hurt that child’s feelings despite this ability. On the other hand, a child with FASD may do something to hurt someone else’s feelings because of an inability to appreciate that person’s reactions. This difference has implications for the development of social-skills training programs. That is, a training program designed for a child with ADHD may include procedures targeting how to translate what the child already knows into actions, while a program designed for a child with FASD may address both building specific cognitive skills and practicing appropriate actions.”

“One of the major contributions of this study pertains to understanding what children with FASD look like from a truly clinical perspective,” said Greenbaum, “helping to clarify for clinicians trying to diagnose and treat them the full extent and specific nature of their previously unidentified problems, thus extending treatment possibilities that may help alleviate some of their more debilitating antisocial and behavioral problems.”

One finding with potential for immediate action was that children with FASD have difficulty interpreting social information, including emotions in faces, said Rovet. “These difficulties predict their behavior problems and are linked to their social development,” she emphasized. “It is imperative that these children receive assistance in social and emotional processing domains, specifically targeting interventions to deal with their unique deficits.”

Source: www.MedicalNewsToday l8th July 2009
University of New Mexico School of Medicine Alcoholism: Clinical & Experimental Research

Adolescent alcohol use and behavior problems are influenced by a combination of genetic and environmental factors. A new study has found that socio-regional factors moderate the importance of genetic influences on early adolescent behavior problems in a way that parallels moderating effects observed for alcohol use later in adolescence.
This paper adds to a growing and very promising area of research showing that child and adolescent behavioral problems emerge from an interplay of inherited vulnerabilities and life experiences,” noted Lisa Legrand, research psychologist at the University of Minnesota. “While inherited factors may place an individual at increased risk, psychosocial or environmental exposures may either aggravate or protect against this risk. Moreover, certain environments may actually modify gene expression such that the influence of genes varies by circumstances.”
“Much of the research on environmental influences on alcohol use and behavior problems focuses on the impact of parents and peers,” added Dick. “While these are clearly critical environmental influences, we have also found that socio-regional, or neighborhood influences, also have big impacts on adolescent behavioral outcomes, and these environmental effects have not received as much attention historically.”
Researchers used data from FinnTwin12, a population-based study of health-related behaviors and correlated risk factors that has followed more than 5,000 twins identified in Finland’s Population Registry Center as having been born in the years 1983 through to 1987. Drawing from previous findings that community-level factors such as urban/rural residency, migration rates, and prevalence of young adults can moderate the importance of genetic effects on alcohol use among 16- to 18-year olds, this study looked at their influence on behavior problems at 12 and alcohol use at 14 years of age.
“One of the key reasons this study is important is that it contributes to the growing body of literature showing that environmental influences play an important role in the expression of an individual’s genetic predispositions,” said Dick. “In this case, how important genetic influences are on behavior problems in young girls can vary quite a bit as a function of neighborhoods factors.”
Certain environments appeared to encourage gene expression while others constrained it, observed Legrand. “The environments that produced higher heritability estimates for female behavioral problems were urban, had a relatively mobile population, and were marked by a higher percentage of older adolescents,” she said. “Conversely in rural, stable, and low-adolescent settings, preadolescent behavior problems appeared to be more influenced by the rearing environment.”
It could be that girls are more susceptible than boys to certain environmental influences, Legrand added. “For example, rural females may remain closer to their parents and under the influence of their monitoring and control for a longer time than rural males,” she said. “This is an intriguing area for future research.”
“There is now converging evidence across a number of different studies that behavioral problems in kids are associated with both concurrent and future alcohol problems,” said Dick. “There is evidence accumulating from genetic studies that behavior problems may be one of the first signs of an individual at increased susceptibility for developing alcohol problems.”
Taken together, she cautioned, a key message from this kind of research is that genes are not destiny. “We’re not all equally predisposed to develop alcohol or behavior problems,” she said, “and the environment can be a key factor in whether or not an individual ever develops problems.”
Legrand concurred. “This research offers added evidence that certain environmental factors can modify genetic effects,” she said. “Regardless of an individual’s genetic endowment, Dick’s findings suggest that there are social or environmental factors that can tip the scales and either encourage or inhibit the expression of a genetic predisposition. Thus, her results serve as a reminder that the heritability statistic is always situation specific and that even highly heritable traits can be environmentally influenced.”

Source: Alcoholism: Clinical & Experimental Research (2009, July 20). Genes And The Environment Interact To Influence Adolescent Alcohol Use

Acute and chronic health problems
As alcohol-related diseases such as liver cirrhosis, cancers and heart disease take time to develop; chronic effects resulting directly from alcohol misuse are rarely seen among young people. Thus it is the shorter-term acute effects of alcohol consumption that are more evident in this population. In particular, acute intoxication can occur rapidly and by surprise in children and young people which is probably due to a combination of physiological factors (e.g. limited ability to metabolise alcohol and lower body weight) and socio-cultural reasons (including a lack of experience of the effects of alcohol and drinking in unsupervised contexts). The most common impacts of alcohol intoxication are vomiting ( 60% of children hospitalized for alcohol use) and coma, which in cold environments can result in fatal hypothermia .

Acute health problems
Newburn and Shiner (2001) report that it is highly likely that children’s inexperience of the effects of alcohol intoxication, and the fact that they are more likely to consume alcohol in ‘risky’ environments brings with it an increased risk of accidents and need for hospitalisation . Alcohol use may be a significant contributor to injury in
adolescence and may play a role in more than 50% of traumatic brain injuries in adolescents. Alcohol use was also linked to 80% of adolescent deaths from homicides, suicides and unintentional injuries and to an increased risk of illness and death at an early age, predominantly caused by suicide and violent accidents. Irwin and Millstein (1986) reported that adolescents who were involved in drowning, falls and burns had a greater frequency of blood alcohol levels over 0.10% . It should be noted that reviews in this area are often unclear as to whether hospital presentations relate to acute alcohol effects such as alcohol poisoning, to the consequences of drinking, such as injury or to chronic conditions although the latter are rare in young people20% of young people admitted to hospital for alcohol intoxication. This high risk group consisted of mostly boys from lower socio-economic status groups, who before the acute episode of drunkenness had shown signs of ‘psychiatric insufficiency’, or extreme shyness and a retiring disposition, or restlessness, impulsiveness and aggressive behaviour
.
Such individuals often had difficulties in social adjustment, including problems at school. These children had also been brought up in homes characterized by insecurity, broken families with only one parent (who was often an ‘exhausted’ mother), with an alcoholic or a mentally disturbed parent or in a home marked by disorganization with few good emotional relations. It was also reported that the children had been using alcohol before the acute episode (no information given on use). They were often apprehended on a week day and neither they themselves nor their parents showed notable anxiety reaction with regard to the admission to hospital. This review concluded that in this ‘high risk’ group of children the acute episode of alcohol intoxication was a warning signal for future problems. This compares to a low-risk group (comprising about 50-55%) of cases that would be seen as healthy children from a psychiatric point of view, from secure homes that have shown no previous signs of social maladjustment. They are generally admitted to hospital on a Friday or Saturday night and both they themselves and their parents show anxiety reactions in connection with the event

The current review found very little evidence relating to liver disease in young
people. Saunders and Bailey (1993) reported that the overwhelming majority of deaths from liver disease occur in the over 21’s . Moreover, Clark et al. (2002) reported that serum liver enzymes were typically only modestly elevated in adolescents with alcohol problems. However, Zeigler et al. (2005) later found that serum enzymatic markers of liver damage were elevated in alcohol-abusing adolescents . Whilst there is great inter-individual variability in susceptibility to alcohol-related liver disease, two notable risk factors are the dose of alcohol consumed and the length of time of heavy drinking . Deaths from alcoholic hepatitis or decompensated cirrhosis are rare in patients under 25, but when these
deaths do occur, they are as a result of several years of heavy drinking . Thus although there is no direct evidence that adolescent livers are more susceptible to alcohol than adult livers, the consequences of heavy drinking in adolescence are now being seen in early adulthood with devastating consequences
Source: Impact of Alcohol Consumption on Young People: A Review of Reviews Oct.2008

Research conducted by the Harvard School of Public Health concludes that reducing marketing around college campuses would reduce binge drinking among college students, Reuters reported Sept. 12.

For the study, researchers went to alcohol-serving establishments near 118 U.S. college campuses to determine if there was a link between drinking habits and marketing promotions or advertising. Visits were made to 830 bars, restaurants, and nightclubs and 1,684 liquor stores and other retailers.

The researchers found that campuses with a high number of places either selling beer in volume packages or featuring frequent price promotions had the highest rates of binge drinking.

“It’s not just the advertising dollars. It’s the five-cent and 25-cent beers, it’s the extra pitcher of beer for a penny, it’s the $5 refillable cup. It’s not simply that these things make people drink, but that they make people drink much more,” said Henry Wechsler, lead researcher and director of Harvard’s college alcohol studies program.

The researchers concluded that binge drinking among college students could be limited by controlling the marketing of beer and other alcoholic beverages near campuses.

“You’re not going to make great headway with college binge drinking unless you address the issue of the alcohol environment that envelopes most colleges,” said Wechsler.

The study’s findings were met with criticism from the American Beverage Institute, a lobbying group that represents chain restaurants. The organization said alcohol problems on college campuses are a result of “abusers.”

“What they’re really looking for is a reduction of drinking among all Americans, including responsible adults,” said American Beverage Institute Executive Director John Doyle.

Researchers say that two drug advances may help millions of Americans addicted to alcohol control their cravings, The drug Naltrexone, which was available in capsule form for years, is now offered as a once-a-month injection. “People came in saying that they really wanted to try this because they had a hard time remembering to take the drug on their own,” said lead researcher Dr. Henry Kranzler, a psychiatry professor at the University of Connecticut School of Medicine.

Kranzler’s study, involving 315 patients addicted to alcohol, found that the monthly version of the drug increased the total number of days that the participants abstained from consuming alcohol.

The drug Acamprosate, which is in use in Europe and awaiting approval from the U.S. Food and Drug Administration, also has showed success in studies led by Elizabeth Houtsmuller, a professor of behavioral biology at Johns Hopkins University School of Medicine.

Houtsmuller’s research examined the physiologic and behavioral changes in 10 heavy drinkers who were given daily Acamprosate. The participants were given opportunities to drink during various points in the study period.

The study found that those who took Acamprosate became more sedate than usual. However, it was not clear whether this sedation would discourage repeat alcohol consumption. “It doesn’t work by altering alcohol absorption or elimination,” said Houtsmuller. “And it doesn’t appear to work by changing alcohol’s subjective effects – the alcohol ‘experience’ that people have.”

Kranzler said the medical advances, combined with psychotherapy and assistance from groups like Alcoholics Anonymous, are helping many alcoholics turn their lives around. “We see people getting better all the time,” he said.

New research finds that female executives in the U.K. drink more than men in similar positions, and are more likely to develop alcohol problems than women in lower positions, the BBC reported March 1.

The University College London study said the stress of competing with men for executive positions is contributing to increased drinking among women.

For the study, researchers surveyed 8,000 government employees. The men and women surveyed worked at various levels in 20 agencies in London.

The survey showed that the percentage of men with alcohol problems was the same from clerical to senior-executive levels. Women in lower-level jobs were less likely to have a drinking problem than men in similar positions. But as women advanced to senior-level positions, their drinking surpassed their male counterparts.

“It may be the stress for women of working against a glass ceiling is to blame,” said Jenny Head, a senior lecturer in epidemiology and public health at University College London, who led the research. “It may be that women feel they have to compete on an equal footing and take on male roles and behaviors.”

Head added, “People who find they put in effort and don’t feel they are getting rewards are more at risk of becoming a problem drinker. We have already shown that stressful conditions at work can lead to poorer health for people. This is just another way that stress can impact on health.”

The charity Alcohol Concern said the drinking culture among top executives should be examined. “We have to ask whether women are drinking more because they feel under pressure. But we have to ask what is the drinking culture in this organization at upper levels,” said the charity’s spokeswoman, Anne Jenkins. “Do they feel more stressed, or is it that they are drinking to keep up with their peers?”

Researchers plan to conduct trials to determine whether a skin patch containing the drug mecamylamine can reduce excess drinking by curbing alcohol cravings, Nature reported April 20.

The patch was originally developed as a quit-smoking aid. But preliminary research shows that mecamylamine also may help curb alcohol addiction. An initial study conducted by Jed Rose at Duke University in Durham, N.C., found that people who consumed more than 10 alcoholic drinks a week reduced their intake to six after taking mecamylamine for four weeks.

Mecamylamine, which has been used since the 1950s to reduce high blood pressure, dulls the addictive effects and cravings of drugs by reducing the release of dopamine.

Rose and his team of researchers are applying for funding and ethical approval for a formal trial.

 Some people can drink a lot of alcohol without becoming addicted, and specific genes may help explain why, researchers say. In a new study of Australian twins, scientists found that separate genes appear to be responsible, to some degree, for dependence on alcohol — addiction — and how much people drink. Understanding how these genetic factors work together should give researchers more insight into treatment of alcoholism in its various forms, said study co-author John B. Whitfield, a researcher at Royal Prince Alfred Hospital in Australia.

Alcoholism and alcohol consumption may appear to be similar, but researchers are increasingly studying them separately. Consumption refers to the amount of alcohol that someone drinks, while addiction refers to a person’s inability to go without a drink.

“The transition from social alcohol consumption to alcohol dependence is a gradual process, and it is often hard to notice it,” said Dr. Alexei B. Kampov-Polevoi, an assistant professor of psychiatry at Mount Sinai School of Medicine. “As a result, many alcoholics and their family members continue to think that a person ‘just drinks too much’ while this person already developed alcohol dependence and requires treatment.”

Whitfield and his colleagues examined statistics about alcohol use from three studies of Australian twins completed between 1980 and 1995. The number of twins in the studies declined from 8,184 in 1980 to 3,378 in 1995. The findings appear in the August issue of Alcoholism: Clinical & Experimental Research.

The researchers found twins who were genetically similar were more likely to consume similar amounts of alcohol. According to the study, some genes affected both addiction and alcohol intake, while some just affected addiction.

“We found (as others have also found) that alcohol dependence is partly, but not entirely, due to genetic differences between people who are affected by it and those who are not,” Whitfield said. “We also found that variation in the amount of alcohol that people habitually drink is subject to genetic influence, and that there is some – but not complete – overlap between the genes affecting these two things.”

Howard J. Edenberg, professor of biochemistry and molecular biology at Indiana University, said the findings – that genes separately affect alcoholism and drinking – are “reasonable.” But “that is a long way from identifying individual genes that actually are involved,” said Edenberg, whose own research is looking into that area.

So what should ordinary folks take from this study? “There is no direct and new message for people with alcoholism in their families; they are at higher risk than average but this has been known for some time and there is only a statistical risk, not a certainty by any means,” Whitfield said. “The more positive message for such people, and the community at large, is that we are learning more about alcohol use and alcohol-related problems and their causes.”

A report by Georgetown University’s Center on Alcohol Marketing and Youth found a 39-percent increase in the number of alcohol ads aired on local and cable television in 2002 compared to the previous year. The report also concluded that a greater number of teens are being exposed to alcohol ads on television.   According to the report, there were 289,381 alcohol ads on television in 2002, with a significant increase in ads for distilled spirits and low-alcohol beverages. On a per-capita basis, the study found that more teens than adults saw 66,218 of the ads, a 30 percent increase over 2001. Television shows that attract a large teen audience, such as “Survivor,” “Fear Factor” and “That ’70s Show,” included alcohol ads.

“This dramatic increase in alcohol ads seen by our children in 2002 suggests the problem got worse,” said Jim O’Hara, executive director of the center. “The data demonstrate that the alcohol industry needs to make major changes in its advertising.”

The Distilled Spirits Council of the U.S. (DISCUS) disputed the findings. The industry contends that the “vast majority of alcohol ads are viewed by adults and that self-regulation is working.”

“To make further progress on underage drinking, we must focus on science-based solutions. Study after study shows that parents and other adults are the primary influence over a youth’s decision regarding drinking, not advertising,” said Peter Cressy, president of DISCUS.

Alcohol abuse costs the NHS £1.7 billion a year, with 150,000 alcohol-related hospital admissions each year. Between 30 and 60 per cent of child protection cases involve alcohol. Britain’s drinks industry is now worth more than £30 billion. A 2002 Mintel survey found that 89 per cent of Britons have drunk alcohol at least once. There has been a 50 per cent increase from 1988 to 2001 in the number of women drinking more than 14 units per week. More than 18,000 people were killed or injured in drink-drive accidents in 2000. The British Crime Survey shows 16 per cent of violent acts by strangers are prompted by drugs but 53 per cent by alcohol.

Sources: Alcohol Concern, Interim Report of the Prime Minister’s Strategy Unit (PMSU), 2003 Food and Expenditure Survey, Mintel

A new study presents the highest risk for dependence on alcohol is about age 20-21 years but that for marijuana it is about 17 years. The peak for cocaine dependence was seen to occur at about age 24-26 years and was estimated to be between 18.4-24.5%. Additionally, the authors noted that 5-6% of cocaine users become dependent in the first year of use and 15- 16% had become dependent within 10 years of first use, For those who use marijuana at least once, the probably of becoming dependent was 9% by age 30 though most cases of dependence occurred when users were 15-25 years old. For those who used alcohol at least once, the “estimated cumulative probability of alcohol dependence by age 55 was about 20%… Most cases met that criteria, however, between the ages of 15 and 35 years.”

For recovering alcoholics and ex-smokers, as well as former users of illicit drugs, the mundane trappings of their addictions—ice cubes, ashtrays, straws, needles—exert a strong, long-lasting power to trigger relapse. A new University of Michigan study, published in the current (October 2001) issue of the Journal of Neuroscience, provides experimental evidence supporting a neurological explanation for why cues as innocent as the sound of ice cubes tinkling in a glass can cause “recovered” addicts to experience dangerous drug cravings. “Drug use is known to sensitize’ certain neural systems within the brain, causing changes that are relatively permanent,” says U-M psychologist Kent C. Berridge, co-author of the study with U-M psychologist Cindy L. Wyvell. “This study shows that the brain is vulnerable to cues that trigger irrational ‘wanting,’ even after a long period of remaining drug-free, once sensitized by prior drug use or exposure.” The research was supported by the National Science Foundation and by the National Institute on Drug Abuse.
For the study, Wyvell and Berridge designed an experiment with rats that eliminated several alternative explanations, such as withdrawal symptoms, learned habits or drug pleasure, for the increase in compulsive drug-seeking that is commonly triggered in human addicts by encounters with drug cues.

First, in order to avoid withdrawal symptoms, they trained the rats to press a lever to get a reward of sugar pellets, not an addictive drug. They also taught the rats to associate a 30-second tone with getting sugar pellets, without needing to press the lever. Then they sensitized one group of rats by administering a series of amphetamine injections, while injecting controls with a saline solution. Next, the researchers waited 10 to 14 days to make sure both groups were drug-free, then resumed the experiment. While the rats pressed the lever in hope of getting the sugar reward, they were presented intermittently with the sound cue, to assess the cue’s ability to trigger excessive pursuit of reward.

In the sensitized rats, the cue triggered excessive wanting,” says Berridge. “Whenever a sugar cue (a sound) occurred, rats pressed in a frenzy on a lever that had previously earned them a sugar reward.” In fact, the researchers found that sensitized rats pressed the lever 200 percent more than rats in the control group, an increase equivalent to the behaviour produced in other rats by injecting amphetamine directly into their brains. This showed that sensitization of the brain and direct drug activation of the brain’s dopamine reward-craving system amplified equally the ability of reward cues to trigger excessive ‘wanting.” “Much more remains to be done before we understand how this process works in humans, with drug rewards such as cocaine and heroin, and to a lesser extent, alcohol or nicotine,” says Berridge. ‘But this study is an important step, because it provides the first pure demonstration that neural sensitization causes a specific process— irrational cue-triggered ‘wanting’ for reward—that is a plausible psychological mechanism for relapse. These results from animals based on a natural sugar reward this may be a useful step toward understanding brain mechanisms of cue-triggered relapse in human drug addiction”

 In 2000, an estimated 310,000 people were injured in crashes where police reported that alcohol was present — an average of one person injured approximately every 2 minutes.

Researchers have uncovered a genetic factor that could  predispose certain youths to binge drinking, according to the National Institute on Alcohol Abuse and pr Alcoholism (NIAAA). Researchers from NIAAA and George Washington University in Washington, D.C., found that college students with a particular variant of the serotonin ‘ transporter gene (5-I-FIT) drank more alcohol per occasion, drank more often just to get drunk, and were more likely to engage in binge drinking than students without the variant. The research was based on interviews with 262 college students, ages 17 to 23, about their alcohol consumption. The team of scientists then analyzed the genetic profiles of the participants. The 5-HTT gene is involved in recycling the chemical serotonin after it is secreted into the synapse of a cell. Rather than having one long and one short variant of the serotonin-transporter gene, study participants found to be predisposed to harmful drinking behaviour had duplicate copies of the short version.

‘Taken together with other research, this finding suggests that genetically mediated differences in serotonergic response play an important role in mediating patterns of alcohol intake,” said Paolo B. DePetrillo, M.D., a clinical investigator at NIAAA. The study also found that students with at least one copy of the long variant of the gene were more likely to consume fewer drinks at one sitting, even though they went out to drink as often as the other students. “This research provides important new evidence that the risk of developing a maladaptive pattern of alcohol consumption is influenced by genetically determined neurobiological differences that exert their effects during young adulthood,” said Ting-Kai Li, M.D., director of NIAAA.

A 15-year study has resulted in the identification of a specific gene that may increase the risk of alcohol  dependence. The $65 million federally-funded Collaborative Study on  the Genetics of Alcoholism (COGA) included 10,000 participants with a history of alcohol addiction. The research was conducted at six locations. In St. Louis, scientists isolated a gene on chromosome 15 that appears to be connected to alcohol addiction. The gene is involved in the regulation of gamma-amino butyric acid (GABA), which is a chemical in the brain that helps to send messages between neurons. Previous research has shown that GABA alters behaviour and is linked to psychiatric disorders.
Stimulating GABA receptors will increase behavioural effects of alcohol, like motor coordination and reduction of anxiety, said Danielle Dick, a professor of psychiatry at Washington University School& of Medicine in St. Louis and principal author of the study. For another component of the study, researchers are examining a different area of the genome, chromosome 4, to determine whether genes there are connected with alcohol metabolism and brain activity. Researchers involved in the study expect to find several genes associated with alcohol dependence. Such identification could lead to new avenues for medications. “It is important to say that these genes all influence your risk,’ Dick said. ‘There is no one alcoholism gene” The National Institutes of Alcohol Abuse and Alcoholism funded the study. The findings appear in the Jan. 14 issue of the journal Alcoholism: Clinical and Experimental research.

A University of California study shows that teens who work more than 10 hours a week tend to consume  alcohol more heavily than those who work fewer hours or not at all. According to the study of more than 6,500 adolescents, 24 percent of the teenagers who worked more than 10 hours said they drank heavily within the past year. On the other hand, fewer than 10 percent of the teens who worked less hours or not at all reported heavy drinking.
“One of the most consistent and troubling discoveries is that the more adolescents work, the more they drink”, said lead researcher Mallie Paschall. Paschall speculated that working more than 10 hours gives teens the added income to purchase alcohol. In addition, work relationships with older teens and adults who drink may lead them to believe that heavy drinking is socially acceptable.

Australia, drug experts are blaming the flood of so-called designer drinks and sodas on the market for a sharp rise in youth alcoholism. Young people are starting to drink earlier and with greater intensity than ever before. In the last comprehensive survey conducted in 1998, half a million teenagers confessed to drinking every week, a quarter of those downing seven or more drinks at each session. Drug experts say the rise in youth alcoholism in recent years can be linked directly to aggressive marketing strategies, and that tougher regulation of the alcohol industry is needed. The industry needs to be held accountable, to ensure that it markets its products responsibly, and stops producing products designed for junior palates, which make alcohol more appealing to very young people.

In USA 1999,

• Approximately 9% of persons aged 18 to 25 (an estimated 3 million) were dependent on alcohol.
• Almost 4 million young adults aged 18 to 25 had engaged in heavy alcohol use in the past month.
• Rates of heavy alcohol use among young adults aged 18 to 25 were highest for males (19.7%) and whites (15.9%).
• 18% of full-time undergraduates aged 18 to 22 were heavy drinkers as compared with 12% of those who were not full-time undergraduates in the same age group.

A government report on America’s children shows that violent crime, smoking, and heavy drinking among U.S. teenagers are all on the decline, Reuters reported July 18.
However, more children are overweight than ever, the report found. “Most people, about two-thirds, believe that crime is going up among America’s children,” said Dr. Duane Alexander, director of the National Institute of Child Health and Human Development. “The picture painted by this report, based on actual data, paints the opposite picture. “According to the report released by the National Institutes of Health, the Census Bureau, and other agencies, victims reported 413,000 juvenile crimes in 2002, which translates into 17 violent crimes per 1,000 juveniles aged 12 to 17.”This is a 67-percent drop from the 1993 high, and the lowest rate recorded since the national victimization survey began in 1973,” the report stated.The report also found that fewer children are being killed by guns. Last year, firearms were involved in 19 percent of deaths among 15- to 19-year-olds.Exposure to secondhand smoke also fell, the report said, and fewer teens smoked. As recently as 1994, 88 percent of children ages 4 to 11 were exposed to secondhand smoke. The latest report found that rate had dropped to 64 percent. Daily smoking by youth dropped to the lowest rate since 1975, and heavy drinking among teens also declined.source:Reported in Join Together Online. 7.21.2003

Research from the University of Illinois at Chicago (UIC) has led to the discovery of another gene suspected of being linked to alcohol dependency, the Medical Research News reported.Researchers investigated a gene that manufactures a protein called CREB, or cyclic AMP responsive element binding protein. The gene is known to regulate brain function during development and learning.
In animal tests, the researchers found that laboratory mice lacking a copy of the gene consumed excessive amounts of alcohol, preferring ethanol to water in a maze test. The mice also exhibited highly anxious behavior. Mice that had two copies of the CREB gene did not exhibit the same signs. “This is the first direct evidence that a deficiency in the CREB gene is associated with anxiety and alcohol-drinking behaviors,” said Subhash Pandey, associate professor of psychiatry and director of neuroscience alcoholism research at the UIC College of Medicine.

A new study concludes that people who misuse alcohol and other drugs are responsible for about 25 percent of all violent crimes. Seena Fazel of the University of Oxford in England and Martin Grann of the Karolinska Institute in Stockholm, Sweden, compared Sweden’s national crime register for the years 1988-2000 with hospital discharges of individuals diagnosed with alcohol and other drug misuse and psychoses. The researchers found that 16 percent of violent crimes, including murder, robbery, assault, and rape, were committed by individuals who had been discharged from the hospital after treatment for alcohol misuse, while 10 percent were linked to those who misused drugs such as amphetamines and opiates.

“It is likely you will find the same sort of figures in Western Europe and North America,” said Fazel. “There needs to be more integration between the criminal-justice system and mental-health services because of this close association between crime and people who leave hospital with drug and alcohol problems.” The researchers concluded that, “Using resources to treat people with these problems could be cost-effective in terms of crime reduction.” In particular, Fazel said that treatment should be considered if a person has been convicted of a violent crime. “Probation officers and mental health professionals should continue to work more closely,” he said.

The number of American adults misusing alcohol is on the rise, with young minorities at particularly high risk. However, alcohol-dependence rates have declined, which researchers attributed in part to a decrease in heavy drinking. The (NESARC) finds that 17.6 million Americans were either dependent on alcohol or misused it in 2001-2002, compared with 13.8 million adults in 1991-1992. The rate of alcohol misuse increased from 3.03 percent of the population to 4.65 percent during the decade, while the rate of alcohol addiction declined from an estimated 4.38 percent of the population to 3.81 percent.

The study said that alcohol misuse and addiction in 2001-2002 was significantly higher among men than women, as well as among individuals in the 18-29 and 30-44 age groups. In addition, there was a significant increase in alcohol misuse among black and Hispanic men, and Asian women aged 18-29 years. Alcohol-addiction rates significantly increased among black women and Asian men aged 18-29, researchers added.The findings were based on interviews with 43,093 individuals.

“The NESARC report reinforces the need for ongoing research to define genetic and environmental factors that contribute to alcohol abuse and dependence, as well as current NIAAA initiatives for the early identification of at-risk drinkers and the application of research-based interventions in vulnerable populations, especially underage drinkers,” said Ting-Kai Li, M.D., director of NIAAA. “The fact that alcohol disorder rates are highest among young adults underscores the need for concerted research on drinking patterns that initiate in adolescence.”

NEW YORK (Reuters Health) – Teenagers may be more likely than adults of legal drinking age to come across alcohol ads in their favorite magazines, new research suggests.  The study of advertisements in 103 national magazines found that while readers between the ages of 12 and 20 were seeing fewer alcohol ads in 2002 than in 2001, they were still exposed to such images more often than older readers were. And girls appeared particularly likely to be bombarded with alcohol advertisements.

The researchers say they would like to see the alcohol industry do a better job of targeting its ads toward legal drinkers while minimizing underage exposure. They report the findings in the July issue of the Archives of Pediatrics & Adolescent Medicine.The authors estimate that in 2002, a reader between the ages of 12 and 20 saw 45 percent more ads for beer and ale than one who was at least 21 years old. Underage readers also saw more ads for distilled spirits and beverages known as low-alcohol refreshers.

That latter category — a group of typically sweet, fruity drinks — was the only one for which teen ad exposure grew between 2001 and 2002. Girls saw 216 percent more ads for low-alcohol refreshers in 2002, while boys saw 46 percent more.In general, the study authors found, teenage girls were particularly overexposed to alcohol advertising in magazines. They estimate that ads for beer and low-alcohol refreshers were slightly more effective in reaching underage girls than women between the ages of 21 and 34, the age group the alcohol industry considers its prime target.

There’s no evidence that the industry is deliberately targeting underage readers with its ads, study leader Dr. David H. Jernigan told Reuters Health.But the findings suggest a need for tighter control over who sees such advertising, according to Jernigan, who is research director at the Center on Alcohol Marketing and Youth at Georgetown University in Washington, D.C.”We hope that the industry will do a better job of keeping ads from the eyeballs of youths,” he said. Jernigan also advocated ongoing research — conducted, possibly, by public health officials — to monitor how well alcohol advertisers are regulating themselves.

The question of whether alcohol advertising actually encourages kids to drink is controversial, and Jernigan noted that research has yielded mixed results. Parents and peers, he said, are clearly big influences. Still, concern over the effects of ads is high enough that the Institute of Medicine, an independent organization that advises the federal government, has recommended that alcohol companies put stricter limits on where they place ads.

In the current study, a handful of magazines — such as Cosmopolitan, Rolling Stone, Sports Illustrated and Entertainment Weekly — were responsible for the bulk of teenagers’ exposure to alcohol ads. Why girls appeared particularly overexposed to the ads is unclear, Jernigan said, but one reason could be that girls read women’s magazines more often than boys read publications for men.

An editorial published with the study calls for more research into the relationship between advertising and underage drinking. In it, Dr. Ralph Hingson of the Boston University School of Public Health points out that the alcohol industry spent $4 billion to promote its products in 2001.”Given the unprecedented surge in alcohol advertising and promotion,” he writes, “new rigorous studies are needed to establish whether those practices are increasing youth exposure to alcohol ads and in turn increasing their alcohol use.”

SOURCE: Archives of Pediatrics & Adolescent Medicine, July 2004.

A new World Health Organization (WHO) study concludes that alcohol use is just as damaging to individual health as tobacco use. Study co-author Jurgen Rehm, an addiction specialist and a senior scientist at the Centre for Addiction and Mental Health at the University of Toronto, said alcohol’s risks have been understated because several studies have shown that a drink a day can reduce the risk of heart attacks. As a result, he said, the industry has been able to escape the harsh health warnings associated with cigarettes even though alcohol is an obvious public-health threat.

According to Rehm’s study, the health benefits of alcohol use are generally overstated, and are virtually non-existent for young people. “Even small amounts of alcohol increase the risk of injury and boost the chances of developing about 60 diseases, including several cancers, liver cirrhosis, and neuropsychological disorders,” Rehm’s report said. The WHO said the report’s findings should serve as a stepping-stone for an international debate about the need to reduce global alcohol consumption.

Britons drink less per capita than other Europeans, but the way they drink has earned them the unenviable title of worst binge drinkers in Europe.According to a report by the British government, 40 percent of all drinking occasions by men and 22 percent by women meet the definition of binge drinking. “If present trends continue, they would rise to near the top of the consumption league within the next 10 years,” the report said. The report also found that British children under age 16 are drinking twice as much as kids the same age drank 10 years ago. The government has called for a “more civilized” late-night culture. “We’ve got to try to get into a culture where the whole of our entertainment isn’t just about alcohol,” said Hazel Blears, a government minister. “It should be about cinema, theatre, about bowling, about a range of things.”

A poll commissioned by the group Alcohol Concern shows that only 7 percent of men in Britain and 22 percent of women know how much alcohol experts believe can safely be consumed in a day.  In addition, the poll of 1,001 adults from throughout Britain also found that many were unaware of the harmful health effects of binge drinking and drunkenness. As a result of the study’s findings, Alcohol Concern is calling on the British government to move forward with its national plan for reducing the harm caused by alcohol. “It was promised for this summer and never came, then it was promised for the autumn, but we’re still waiting. The sooner ministers implement a national strategy in England, backed with significant investment, the sooner we can reverse the growth in binge drinking and reduce alcohol dependency,” said Eric Appleby, chief executive of Alcohol Concern. Government research released last month found that alcohol increases criminal behavior. According to the report, drinking was linked to one million fights a year, 19,000 sexual assaults, and 360,000 cases of domestic violence. Government statistics also show that an estimated six million people in Britain binge drink, while eight million drink more than the medically established limits of three to four units of alcohol for men and two to three for women.

A study of alcohol-company websites finds a high number of visits from underage youth, attracted to such features as video games, music, e-mail gadgets, and icons, Researchers at the Center on Alcohol Marketing and Youth at Georgetown University estimate that nearly 700,000 minors visited alcohol-company websites from July through December. “These alcohol websites are a virtual cyber-playground with no adult supervision,” said Jim O’Hara, director of the center. “If a liquor store were this ineffective in policing underage visits, the community would be up in arms.”

Frank Coleman of the Distilled Spirits Council of the U.S. dismissed the study, calling it a publicity stunt to raise funds. He said the Federal Trade Commission has “reviewed our ads and said they were directed to adults, that our Web content is directed to adults, and that 99.9 percent of them had age verification in place, in addition to having responsible-drinking messages throughout.”

But O’Hara said the study monitored actual Internet usage through the audience-measuring service comScore Media Matrix. It found that 13 percent of all visitors to 55 alcohol company websites were minors. Bacardi’s site had 59 percent of underage visitors, while Anheuser-Bush’s Budweiser and BudLight sites received more than 90,000 underage visits during the six-month study period. O’Hara added that parental controls on computers were not sufficient to block entry to the sites. Furthermore, the age-verification features on the websites were unable to truly verify the visitor’s age. O’Hara said the websites violate the industry’s marketing advertising codes by offering youth-oriented activities, such as downloadable music and video games. “There are a lot of features that appear to be in conflict with the industry’s own marketing and advertising codes, where they shouldn’t be using toys and games,” O’Hara said.

A new study published in the Archives of Internal Medicine found that people who are admitted to hospitals often have alcohol use disorders that go undetected. 

Authors Barbara A. Smothers, Ph.D., and Harold T. Yahr, Ph.D., of NIAAA, follow up on their study from last year which found that nearly one-quarter of hospitalized individuals who identified themselves as drinkers met diagnostic criteria for alcohol use disorders. In the new study, the authors analyzed hospital record data to estimate rates of alcohol use disorders detection among those whose diagnostic interviews indicated the presence of alcohol use disorders. “We found that alcohol diagnoses were reflected in the hospital records of fewer than half of those who evidenced an alcohol use disorder in their interview,” said Dr. Smothers. “We are concerned about the low detection rates, but we also are concerned that only half of those detected had documentation of alcohol intervention or treatment referral.”

The researchers conclude that “hospitalization provides an excellent opportunity for identifying alcohol problems among patients and providing them with alcohol intervention or treatment referral services as needed.” They add that screening should be a routine part of the hospital admission process, and medical students, residents, and practicing physicians need education to address this problem. “By routinely screening all hospital patients who report current alcohol use,” said NIAAA Director Ting-Kai Li, M.D., “we could help many individuals avail themselves of the alcohol misuse therapies from which they might benefit.”

In the largest study of its kind, researchers have found that consuming two to six alcoholic drinks per week was associated with a reduced risk of sudden cardiac death in men, according to a report in  Journal of the American Heart Association.

“This is the largest prospective study to look at alcohol consumption and sudden cardiac death in men and the first prospective study to find a reduction in sudden cardiac death from light drinking,” says Christine M. Albert, M.D., associate physician in the division of preventive medicine at Brigham and Women’s Hospital and instructor of medicine at Harvard Medical School in Boston. Albert is also a cardiac electrophysiologist at Massachusetts General Hospital.

Researchers looked at 21,537 men involved in the Physicians Health Study, a long-term study of male physicians and risk factors for heart disease. All of them were free of cardiovascular disease and provided information on their consumption of alcoholic beverages. During 12 years of follow up, there were 141 cases of sudden cardiac death. The risk of sudden cardiac death was reduced by 60 percent in men who drank two to four drinks per week, and 79 percent in men who consumed five to six drinks a week, less than one drink per day on average.

About half of all deaths from coronary heart disease are sudden and unexpected. Sudden cardiac death usually occurs when the heart begins beating too rapidly or chaotically to pump blood efficiently. It claims the lives of about 250,000 Americans each year. Although these findings are considered significant, Albert says they should alone not be used to generate guidelines on drinking and heart disease. Light drinkers in this study may have had other health behaviors that lessened their risk of sudden cardiac death. Researchers did not compare the effects of drinking patterns, such as consuming small amounts of alcohol daily versus drinking all of the alcohol in one sitting, which could have harmful effects. Scientists know that binge drinking – consuming large quantities of alcohol in a brief period – causes abnormal heart rhythms that can lead to sudden cardiac death.

“Based on the data, I wouldn’t recommend that non-drinkers start drinking. One has to consider all the risks and benefits of drinking alcohol,” Albert says. “You don’t know how likely a person is to become addicted to alcohol, and there is also the risk of cancer to consider.” Previous studies have found evidence that heavy alcohol consumption may increase an individual’s risk of certain types of cancer. “Consuming more two or more drinks per day has been associated with an increased breast cancer risk in women,” Albert says, adding “this study was done only in men, so we can’t be sure if our results would apply to women as well.

“Other studies have shown that the risk of sudden cardiac death increases with heavy alcohol consumption,” she says. “Our study found the risk began to increase at more than two drinks per day.  For now, it appears that drinking a small amount of alcohol doesn’t increase a man’s risk of sudden cardiac death and may actually decrease it. So if someone drinks in small amounts it’s probably fine to continue,” she says. As for how alcohol might reduce the risk of sudden cardiac death in men, Albert says one explanation might be that it reduces the formation of blood clots in arteries, which can cut off the flow of oxygen-rich blood to the heart. Small amounts of alcohol also may reduce fatal disturbances in the heart’s rhythm.

Source: JoAnn E. Manson, M.D., Dr. P.H.; Nancy R. Cook, et al, Report in
 Journal of the American Heart Association, 31 Aug 2004

A new survey shows that at least one-third of young professionals employed at leading corporations in Britain are working with hangovers at least twice a week. In addition, 48 percent of young upscale professionals said they had a hangover at least one working day a week.

As part of a “lifestyle” survey for a herbal hangover remedy, Harry Briggs and Marcus Waley-Cohen interviewed 500 friends, acquaintances, and colleagues from Eton, Oxford, and Edinburgh universities, as well as in London. The participants work in a variety of professions, including banking, law, television, advertising, management consulting, and accounting. Briggs and Waley-Cohen found that the drinks of choice among young professionals are exotic cocktails and champagne.

“People in their early, and to a lesser extent their late 20s, like to party, and partying involves alcohol — champagne, cocktails, or vodka and Red Bull, which actually tastes horrid but stops you from falling asleep after you’ve spent a day at your desk,” said Waley-Cohen. “Occasionally, at a country-house party, you’ll get smashed from Saturday afternoon until the early hours of Monday. But mostly people are quite sensible about going a bit easy on a work night.”

The survey also showed that young female professionals reported having hangovers nearly twice as often as their male colleagues. “When it comes to Mojitos or Cipriani, the girls easily keep up, drink for drink,” said Briggs. Lee Lixenberg, spokesman for Alcohol Concern, said the results are not surprising. “Alcohol is a disinhibitor and it’s certainly not a respecter of class,” he said. “Up to 40 million working days are lost each year because of alcohol problems. Class is no guide to the impact that drinking is going to have on a person.”

The Marin Institute for the Prevention of Alcohol and Other Drug Problems has criticized the new film “Dodgeball: A True Underdog Story” for marketing beer to teenagers through product placement, The movie, which was the nation’s No. 1 film in its first week of opening, is rated PG-13. However, the movie prominently displays packaging and signs for Budweiser and Bud Light, brands sold by Anheuser-Busch.

Amon Rappaport, communications director at Marin, said the beer company took advantage of the lack of guidelines for advertising in movies. The current voluntary guidelines for placement of beer ads are for print and television ads, not movies. They call for brewers to run ads only where at least 70 percent of the audience is above the drinking age.

John Kaestner, vice president for consumer affairs at Anheuser-Busch, contends that the company only places its products in movies with an adult appeal. “Just like ‘The Stepford Wives’ and ‘The Terminal,’ which are rated PG-13, ‘Dodgeball’ appeals to an adult audience,” Kaestner said.

Created and sponsored by the Uhlich Children’s Advantage Network (UCAN) located in Chicago, Illinois, the report card is an annual measure of adult progress on issues affecting teens, as graded by teens themselves. Conducted in January and February of 2004, the representative sampling consists of 1,000 teenagers, ages 12 to 19. Teens received the questions in the form of a mail survey, with the results weighted to reflect regional, ethnic and gender distribution across the United States. The research division of the Child Welfare League of America (CWLA), in Washington, D.C., provided long-term trending analysis of the grades received by the adults.

CWLA’s analysis revealed:

• Adults can take pride that they received consistently high “B’” range grades over the six-year period in “providing a quality education for young people,” even though students in urban focus groups often felt that resources at many city schools did not match those of the suburbs.
• Each year between 1999 and 2004, over 50% of young people consistently gave above average grades (A’s and B’s) to adults in the following categories: “Providing a Quality Education for Young People,” “Creating Job Opportunities for the Future,” and “Spending Quality Time with their Families.”
• Each year between 1999 and 2004, over 35% of young people consistently gave failing grades (D’s and F’s) to adults in the following categories: “Really Listening to – and Understanding Young People,” “Getting Rid of Gangs,” “Stopping Young People from Smoking,” “Stopping Young People from Using Drugs,” and “Stopping Young People from Drinking.”
• For the sixth straight year, teens gave the lowest grade to adults in stopping young people from drinking.
• Teens have given adults a wide range of grades on “running the government” over the six-year period, including a “D+” in 1999, a “B-” in 2002, and “C’s” in 2003 and 2004.

The U.S. Food and Drug Administration has approved a drug that may reduce alcohol cravings in problem drinkers who have quit. The FDA approved Campral (generic name: acamprosate) after studies showed that more subjects who were given the drug stayed away from alcohol, compared with those who were given a placebo. The drug has been used in Europe for 15 years.

“While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse,” the FDA wrote. However, the FDA said that Campral might not be effective for people who are currently drinking when they start taking the drug, or for those who are misusing other substances.

Campral, which is manufactured by Lipha Pharmaceuticals, a subsidiary of German drug maker Merck KGaA, could be on the market by the end of this year. Forest Laboratories Inc. owns the licensing rights to sell the drug in the United States.

UK medical researchers have suggested that weekend binge drinking may be linked to a peak in deaths from heart attacks on Mondays.

A letter to the British Medical Journal from Lauren Chenet and Annie Britton of the London School of Hygiene and Tropical Medicine said alcohol, particularly when consumed in a binge, acts as a trigger for heart attack.

“The Monday peak in cardiovascular mortality and morbidity has been documented in various settings,” they write.

Studies that look at the pattern of drinking, either directly or indirectly, have consistently found an increased risk of cardiovascular death (particularly sudden death) with binge drinking.

In countries such as the former Soviet Union and Scotland, the Monday peak is pronounced and is accompanied by slight increases in mortality on Saturdays and Sundays.

Physiological studies suggest moderate drinking (between seven and 14 drinks per week) has a protective affect on the heart possibly through boosting high density lipoproteins (‘good’ cholesterol) and reducing the risk of blood clots.

Binge drinking, on the other hand, appears to cause dehydration and may actually promote clotting after heavy drinking stops.

Binge drinking also changes heart rhythms, increases blood pressure and may damage the lining of blood vessels and the heart muscle which is especially sensitive during withdrawal.

Australian cardiovascular expert, Professor Lawrence Beilin from the University of Western Australia, said he was not aware of any similar Australian studies.

He said, however, the argument put forward by Chenet and Britton was plausible and he suspects the same situation exists here.

Source:Anna Salleh – ABC Science Online April 2001

BLOOMINGTON, IN – A new report by the Indiana Prevention Resource Center at Indiana University Bloomington presents promising findings on adolescent use of alcohol, tobacco and other drugs. Most of Indiana’s adolescents continue to make the healthy decision to avoid drug use, but some of the findings signal a need for increasing prevention efforts statewide.

Here are some of the findings from the 14th annual survey of alcohol, tobacco and other drug use by Indiana children and adolescents:

• Cigarette use in all grades showed a steady decline
• Fewer adolescents chose to use marijuana
• Ninth- through 12th-graders did less binge drinking
• Smokeless tobacco use increased in all grades except 12th
• Older adolescents reported more use of club drugs than younger cohorts
• Inhalant use among sixth- through 11th-graders increased

The 2004 results, which can be found at www.drugs.indiana.edu/survey/atod/index.html, are based on surveys completed by 91,577 students in grades six through 12, attending 297 schools in Indiana. The purpose of the survey is to help state and local entities coordinate prevention programs by providing them with current information regarding adolescent use of these unhealthy and in some cases illegal substances. The annual survey is funded by the Indiana Family and Social Services Administration, Division of Mental Health and Addiction.

For the most part, illicit drug use by Hoosier adolescents is continuing a slow decline that began five to six years ago. E. Lisako Jones-McKyer, survey director for IPRC and assistant professor in IUB’s Department of Applied Health Science, which is part of the School of Health, Physical Education and Recreation, said that state and local entities have made improving adolescent health their top priority and that these trends mirror their efforts. The “Afternoons R.O.CK. in Indiana” program is an example of this collaboration.

Coupled with these positive trends is the need to increase prevention efforts among lower grades for all categories, Jones-McKyer said. She noted that inhalant use increased in all grades except 12th. Among younger adolescents, she said, the rates have risen to levels reported in the late 1990s.

“It is my belief that youth’s knowledge of products that can be used as inhalants has expanded exponentially in recent years,” Jones-McKyer said. “Results in this year’s survey suggest a need to address prevention efforts in this realm.”

She said another significant finding is the decreased use of cigarettes but increased use of smokeless tobacco.

“This finding suggests the need to broaden prevention efforts beyond cigarettes to include all tobacco products,” she said.

Mohammad R. Torabi, Chancellor’s Professor and chairperson in the Department of Applied Health Science as well as IPRC’s interim director, said the successes identified in this year’s report should be celebrated but more work lies ahead.

“While Indiana has made great progress in the past 10 years, we still have a long way to go,” Torabi said. “Knowing that children and adolescents are the most important asset of our state, it is imperative that we continue to monitor drug use among this group and continue comprehensive drug education, along with enforcement of policies for ultimately eliminating these problems.”

The following is a summary of the survey results broken down by substance. From the early to mid-1990s, Indiana saw a dramatic increase in drug use among its youth. This usage peaked in 1996, followed by a slow and steady decline among youth in most age groups.

Tobacco use a mixed bag

Cigarette smoking rates continued to decline, albeit slightly, but the survey found an increase in the use of smokeless tobacco. The use of smokeless tobacco increased in every grade except 12th. The monthly usage reported ranged from 1.3 percent of sixth-graders to 8.7 percent of high school seniors.

The continued decline in cigarette smoking pleases public health experts because cigarettes are considered a “gateway drug,” which can lead to the use of other drugs. Smoking rates are the best statistical predictor of other types of drug use by children and adolescents. The percentage of students who reported smoking at least one cigarette in the last month ranged from 5.4% of sixth-graders to 27.4% of seniors. The percentage of seniors smoking at least once a month decreased 1.4% from the previous year.

Drug use down

Indiana prevalence rates for marijuana and most other illicit substances are still higher than the rates reported in 1991 and 1992. However, the data from the past five to six years indicate that in general, illicit use of most drugs by youth is slowly yet steadily declining. Monthly marijuana use ranged from 2.5% of sixth-graders to 18.3% of seniors.

Alcohol use rate continues to decline Monthly use of alcohol declined more than 4 percentage points among 12th graders and for the second consecutive year is more than 5 percentage points below the national rate. Binge drinking rates among ninth- through 12th-graders showed signs of decline and finally dropped below the national rates. Monthly alcohol use rates ranged from 9.8% for sixth-graders to 42.2% for 12th-graders.

Similar to findings in the 2003 report, however, alcohol use among sixth- to eighth-grade students does not show signs of decreasing. Rates of binge drinking among sixth- and seventh-graders increased, though they are still much lower than two years ago.

“Club drugs” potential trends

This is the third year in which students were asked about usage of the “club drugs” ecstasy (MDMA, 3,4-methylenedioxy-methamphetamine), GHB (gamma hydroxy butyrate) and Rohypnol (flunitrazepam). Since 2000, there has been a dramatic increase in the number of police encounters with the club drugs. The 2004 survey found that rates of club drug use in all grades have either stabilized or declined. Older students are still more likely to use the drugs, indicating that use of these substances is still age-dependent and associated with accessibility. As suggested in reports from the past three years, club drug rates should be closely monitored in order to ensure timely prevention efforts.

Inhalant use increases For the third year, inhalant use increased among all grades except 12th. Among younger adolescents, the rates have reached levels reported in the late 1990s. The percentage of students who reported using inhalants at least once in the last month ranged from 1.8% of 12th-graders to 4.7% of eighth-graders. On average, 3.5% of the students reported using an inhalant in the last month, compared to 5.1% who reported a monthly usage in 1996.
Source: newsinfo.iu.edu, 2004

A study by the Center on Alcohol Marketing and Youth at Georgetown University finds that television ads for alcohol increased 97% from 2001 to 2003,

In Omaha, Neb., the report said, more than 124,000 alcohol commercials were aired on television in 2003, with 26% of the ads reaching viewers under the age of 21.

Furthermore, the study said that the most popular advertising times for alcohol advertisers were during the top 15 teen programs.

“Whether it’s by choice or by accident, certainly over a quarter of those ads were aimed at or were more likely to be seen by audiences primarily of youth,” said Loel Schettler of Project Extra Mile, an anti-drinking group in Omaha.

Budweiser of Omaha contends that it targets its advertising to an older age group. “Our target demographic is a little heavier male in the 25 to 49 demo,” said Mary Wajada, Budweiser’s public-relations director. “We have never been — nor will we ever be — trying to promote underage drinking.
Source: KETV-7 , Omaha reported Oct. 12. 2004

The American Medical Association (AMA) said that drinking is increasing among teenage girls, a result of the alcohol industry’s aggressive promotion of sweet, fruity drinks, the Associated Press reported Dec. 17.

According to an Internet poll of 741 teens released by the AMA, 13 was the average age when girls tried their first alcoholic drink. By age 18, one in three have tried what the AMA refers to as “alcopops,” or sweet, fruity alcoholic beverages.

“The percentage of girls who drink is on the rise faster than boys,” said AMA President-elect J. Edward Hill.

Young girls are attracted to the sweet taste of alcopops; Hill said that, “the key to the beverage companies’ success, we think, is their aggressive advertising.”

In responding to the AMA report, the Washington-based Beer Institute said, “flavored alcohol beverages are not new products in the marketplace, and marketing for these products is directed at adults.”

To address the situation, the AMA is urging the medical community to focus on changing the social environment that encourages teens to drink.

“In the past, a lot of the effort went to telling youths not to drink and punishing them if they did,” said Dr. Richard Yoast, director of the AMA Office of Alcohol and Other Drug Abuse. “That effort was only marginally successful.”

The AMA’s campaign includes posters for doctors’ offices titled “Girlie Drinks — Women’s Diseases.” The poster provides information on the potential risks of drinking, such as brain damage and menstrual disorders.

“We are really trying to get physicians to talk about alcohol with their patients,” Yoast said. “If you ask adults, ‘Do kids drink?’ they’ll probably say, ‘Oh, yeah.’ But when you ask, ‘Do they know how many young girls drink?’ they may pause.”

CHICAGO – The American Medical Association (AMA) released the results of two nationwide polls today that reveal the extent of underage consumption and marketing exposure to “alcopops” or so-called “girlie drinks.” The AMA expressed concern that hard-liquor brands are using these sweet-flavored malt beverages as “gateway” beverages to attract less-experienced drinkers.

“We’re alarmed and concerned with these findings,” said J. Edward Hill, president-elect of the AMA. “The percentage of girls who drink is on the rise faster than boys, and the average age of their first drink is now 13. These troubling trends make the aggressive marketing of so-called alcopops even more dangerous.”

The AMA said the poll results underscore the need for physicians to counsel young patients and parents of adolescent children on alcohol use, health risks and advocate for policies that protect underage youth from the marketing tactics of the alcohol industry. The polls were funded as part of the AMA’s partnership with The Robert Wood Johnson Foundation.

To assist physicians in their educational efforts, the AMA unveiled an informational poster for use in physicians’ offices. The Girlie Drinks poster is the first in a series of educational materials that are being developed for physicians’ offices that will help start a dialogue on this important health issue. The poster is available online here.

“We urge physicians who care for young people to use these posters to help inform their patients,” Dr. Hill said. “Alcopops are marketed as fun, sexy and cool as if they are less risky to drink, but their health and safety consequences are anything but sexy or cool. The difference in female physiology means that teen girls feel greater impairment from alcohol and encounter alcohol-related problems faster, including brain damage, cancer, cardiac complications and other medical disorders.” .

Key findings of the two polls released Thursday include: .

• Approximately one-third of teen girls report having tried alcopops, and one out of six have done so in the past six months.

• More teen girls have had alcopops in the past six months than teen boys (31% versus 19%).

• Teen girls report drinking alcopops more than other alcoholic drinks, whereas adult women age 21 or older rank it as their least-consumed alcoholic beverage.

• For teens who have had alcoholic drinks in the past six months, girls drank more in all categories (beer, wine, alcopops and hard-liquor drinks) than boys.

• Nearly one in six teen girls who have drunk alcopops in the past six months have been sexually active after drinking.

• One out of four teen girls who have tried alcopops have driven after drinking or ridden in a car with a driver who had been drinking.

• One out of five teen girls who have tried alcopops have thrown up, or passed out, from drinking.

• Half (51%) of teen girls have seen alcopops ads.

• Nearly half of all girls aged 16-18 report seeing alcopops ads on TV, compared to only 34% of women 21 or older.

• Teen girls report seeing or hearing more alcopops ads on TV, radio, billboards, the Internet and in magazines more than women 21 or older

“While the alcohol industry claims to only target legal-age drinkers, their ads reach millions of impressionable young girls,” Dr. Hill said. “Previous studies and these new polls show that teenagers see such ads more so than their legal-age counterparts. Parents should be outraged that these products clearly target and reach underage girls.”

A study released earlier this year by the Center for Alcohol Marketing and Use revealed that girls ages 12-20 saw 95% more magazine ads for alcopops than women over 21. Women 21-34, the age group identified as the target audience for alcohol ads, were actually less exposed per capita to magazine advertising for alcopops and beer than girls aged 12-20.

The AMA polls reveal similar patterns, indicating that underage children see more alcopops ads. In addition, the polls provide insights into the resulting harms from alcopops consumption. The teen survey found that one in six girls who report trying alcopops were sexually active after drinking, and 25% drove a car after drinking or rode with a driver who had been.

The AMA said alcohol consumption contributes to numerous health problems that effect teenage girls as they develop, well into their later years. These include breast cancer, osteoporosis, menstrual disorders, brain function and heart disease. According to the National Institute of Alcohol Abuse and Alcoholism, women drinking at the same rate as men, continue to be at higher risk for certain serious medical consequences of alcohol use including liver, brain and heart damage.

The Journal of Human Resources reported in 2001 that teen girls who binge drink are 63% more likely to get pregnant in their teen years. And compared with non-drinkers, girls who drink suffer from higher rates of depression, suicidal thoughts and complications with puberty and menstruation.

Buffalo, NY – Researchers with the University at Buffalo’s Research Institute on Addictions have quantified the increased risk of having a drinking problem as an adult faced by individuals who start drinking alcohol as adolescents.

The likelihood of alcohol abuse or dependence later in life increases by 12% for each year of decrease in the age at first drink for both men and women, they reported in the September issue of Alcoholism: Clinical and Experimental Research.

They also reported that the earlier an individual began drinking alcohol, the greater the degree of alcohol intoxication experienced routinely on typical drinking occasions in adulthood.

The national telephone survey revealed that men and lifetime problem drinkers reported consuming their first alcoholic drink (other than just a taste) at an earlier age than women or non-problem drinkers respectively.

“We believe that these findings strengthen the argument for identifying individuals who begin drinking at young ages and targeting them for possible prevention efforts,” explained James York, Ph.D., lead investigator on the study.

“The finding of higher and significant correlations between age at first drink and lifetime drinking issues probably reflects the operation of a variety of variables contributing to problem drinking, rather than a direct causal relationship between the age at first drink and later problems.” York is a senior research scientist at RIA with an extensive background in age- and gender-related effects of alcohol, as well as the medical consequences of alcohol and drug use.

Data for the study were drawn from a national telephone survey of 2,276 people (981 men and 1,295 women) between the ages of 18 and 91 who reported how old they were when they had their first drink. The age and race/ethnicity distribution of the sample was similar to that in the general population.

York said women reported taking their first drink at about age 18, while men reported starting to drink at about age 16.

Supporting the view that women are becoming more like men in their drinking habits, the study showed that the age at first drink was more similar for young men and women than for older age groupings by gender. In addition, the prevalence of current drinking (had a drink during past 12 months) was closer for women (67% ) and men (73.4%) in this study than reported in earlier studies.

The study was funded in part by the National Institute on Alcohol Abuse and Alcoholism.

AlcoholScreening.org is a widely promoted, anonymous, and free online service that offers visitors a self-screening of their drinking behaviors, individualized feedback, and, when appropriate, information about treatment. In a study evaluating the use of the site, researchers found the following:

* In a 14-month span, the site recorded over 66,000 visitors. Nearly 40,000 visitors over age 18 completed the screening about their own drinking habits.

* Almost all visitors who completed the screening (90%) were drinking hazardous amounts (determined by the Alcohol Use Disorders Identification Test, AUDIT, and 2 additional quantity and frequency questions; defined as >14 standard drinks per week or >4 drinks per occasion for men, and >7 drinks per week or >3 drinks per occasion for women).

* Most (65%) had possible alcohol abuse or dependence (AUDIT score of >=8).

* Similar proportions of men and women were drinking hazardous amounts.

* After receiving their results, 19% chose the “Learn More” or “Get Help” options on the site. Visitors with more severe alcohol problems were more likely to choose these options.

Comments:

A highly promoted website offering alcohol screening and feedback reported many visits, especially by those drinking hazardous amounts or with possible alcohol abuse or dependence. Further, nearly one-fifth of visitors with alcohol use problems sought more information or help from the site. The success of AlcoholScreening.org suggests that such websites are an efficient and perhaps relatively inexpensive means (at least compared with individual health provider interviews) for targeting hazardous drinkers.

Joseph Conigliaro, MD, MPH

A gradual shift over the past few years has resulted in teenage girls surpassing boys in the amount of alcohol they consume, the Christian Science Monitor reported Aug. 14.

In a study of 12- to 17-year-olds, the National Center on Addiction and Substance Abuse (CASA) at Columbia University in New York identified several factors that motivate girls to start drinking. Among them are an increased presence of drinking in the American culture, rising rates of stress and depression among youth, and absent parents.

Joseph Califano, president of the center, added that, “many girls want to be one of the boys.”

Because alcohol advertisements promote sexuality, Jean Kilbourne, a visiting research scholar at the Wellesley Centers for Women, said alcohol’s disinhibiting effects also appeal to girls who feel enormous pressure to have sex.

A study by the Center on Alcohol Marketing and Youth at Georgetown University in Washington looked at the influence that alcohol advertising has on consumers. For the study, researchers examined the advertising content and readership ages of popular magazines such as Vogue, Cosmopolitan, Maxim, and Sport Illustrated.

The study found that minors saw more alcohol advertising than adults in 2002, with teen girls more likely to be exposed to the advertising than teen boys.

“Targeting women is nothing new,” said Susan Foster of CASA. “The alcohol industry, just like the tobacco industry, knows that if you want a lifetime heavy drinker, the best way is to start them early.”

This interesting study was specifically looking at the “stepping-stone” or “gateway” sequences that link the use of alcohol, tobacco, marijuana and cocaine. The study included information from 44,624 individuals age 12 to 25 years, and was based primarily on “exposure opportunity.” This did not mean seeking out drugs, but rather being exposed to an opportunity to use drugs at a party or a friends home, etc.

The authors, Wagner and Anthony state: “Results indicated that users of tobacco and alcohol were more likely than nonusers to have an opportunity to try marijuana and were more likely to actually use marijuana once a marijuana opportunity had occurred. Opportunity to use cocaine was associated with prior marijuana smoking. Among young people with a cocaine opportunity, those who had used marijuana were more likely to use cocaine than were those with no history of marijuana use.”

New research suggests that people who smoke and drink heavily are more at risk for oral cancer, the Researchers from King’s College in London, England, found an increase in oral cancer among men and women in their 20s and 30s who smoke and binge drink.

The researchers said that when tobacco smoke combines with alcohol, it produces dangerous levels of cancer-causing chemicals that attack the lining of the mouth.

“Our data show that smoking, drinking and poor diet are major risk factors, and that the younger people start smoking and drinking, the higher the risk,” said Newell Johnson, a professor of oral pathology at King’s College

(AP) – Popular teenagers are much more likely to drink, smoke marijuana, shoplift and vandalize property than their less-popular peers, according to a new University of Virginia study.
Researchers said results of their study contradict traditional views about the benefits of being one of the “cool kids” in school.
“We tend to think if kids are well-liked by their peers, that provides a safety net for them,” said psychology professor Joseph Allen, the lead investigator of the study. “Popular adolescents do have many advantages, but we find they are at greater risk for drug use and petty criminal behavior.”
Researchers assessed popularity by asking 500 Charlottesville-area middle school students whom they would like to hang out with. Then they narrowed the pool to 185 adolescents, ranging from “cool kids” to “geeks,” and asked them to respond anonymously to questions about drug use and criminal activity.
The researchers found that at age 13, about 8 percent of all teenagers reported trying alcohol or marijuana. By age 14, those percentages jumped to 26 percent for popular teens and to only 9 percent for less popular teens.
The cool kids were also about three times more likely to participate in petty criminal behavior such as vandalism, knocking down mailboxes and shoplifting.
“One of the stereotypes is that the kids we see as successful don’t do these kinds of things, but it’s much more complicated than that,” said David Waters, a U.Va. professor and family therapist. “The truth is, they do these things and they do them more than other kids.”
“The point isn’t that we need to watch these kids like hawks, but it’s good to know which kids are more apt to do this and not automatically blame the disaffected and the lonely,” Waters said.
Allen said popular teens tend to be friendly, outgoing people who want to get along with others. He said these traits make them vulnerable to peer pressure.
“Popular adolescents look like leaders. But in reality they are tracking peer opinion,” Allen said. “They do the same thing politicians do in tracking opinion polls. They are very much like politicians.”
The message for parents, Allen said, is that they should be aware of who their children’s friends are. He said popular teens who associate with more “straight-laced” groups get into less trouble.
“Popular kids tend to have good relationships with their parents,” he said. “So parents need to use their influence with them and communicate the norms of the family and why they’re important.”

An analysis of the 2003 National Survey on Drug Use and Health concludes that individuals who began drinking in their teens are more likely to have alcohol dependence or misuse problems as adults, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).According to the survey of 70,000 people, individuals who first used alcohol before age 15 were five times more likely to later become dependent on alcohol or have alcohol-related problems, such as trouble with the law due to alcohol or physical dangers.

Source. “Alcohol Dependence or Abuse and Age of First Use” Report, SAMHSA October  2004

A report by Georgetown University’s Center on Alcohol Marketing and Youth found a 39-percent increase in the number of alcohol ads aired on local and cable television in 2002 compared to the previous year. The report also concluded that a greater number of teens are being exposed to alcohol ads on television, the
According to the report, there were 289,381 alcohol ads on television in 2002, with a significant increase in ads for distilled spirits and low-alcohol beverages. On a per-capita basis, the study found that more teens than adults saw 66,218 of the ads, a 30 percent increase over 2001. Television shows that attract a large teen audience, such as “Survivor,” “Fear Factor” and “That ’70s Show,” included alcohol ads.

“This dramatic increase in alcohol ads seen by our children in 2002 suggests the problem got worse,” said Jim O’Hara, executive director of the center. “The data demonstrate that the alcohol industry needs to make major changes in its advertising.”

The Distilled Spirits Council of the U.S. (DISCUS) disputed the findings. The industry contends that the “vast majority of alcohol ads are viewed by adults and that self-regulation is working.”

“To make further progress on underage drinking, we must focus on science-based solutions. Study after study shows that parents and other adults are the primary influence over a youth’s decision regarding drinking, not advertising,” said Peter Cressy, president of DISCUS.

Source: Associated Press April 21.2004

New research suggests that people who smoke and drink heavily are more at risk for oral cancer, the Researchers from King’s College in London, England, found an increase in oral cancer among men and women in their 20s and 30s who smoke and binge drink.

The researchers said that when tobacco smoke combines with alcohol, it produces dangerous levels of cancer-causing chemicals that attack the lining of the mouth.

“Our data show that smoking, drinking and poor diet are major risk factors, and that the younger people start smoking and drinking, the higher the risk,” said Newell Johnson, a professor of oral pathology at King’s College

Source: Daily Telegraph, London reported Nov. 9.2004

WEDNESDAY, Aug. 18 (HealthDayNews) — Some people can drink a lot of alcohol without becoming addicted, and specific genes may help explain why, researchers say.

In a new study of Australian twins, scientists found that separate genes appear to be responsible, to some degree, for dependence on alcohol — addiction — and how much people drink. Understanding how these genetic factors work together should give researchers more insight into treatment of alcoholism in its various forms, said study co-author John B. Whitfield, a researcher at Royal Prince Alfred Hospital in Australia.

Alcoholism and alcohol consumption may appear to be similar, but researchers are increasingly studying them separately. Consumption refers to the amount of alcohol that someone drinks, while addiction refers to a person’s inability to go without a drink.

“The transition from social alcohol consumption to alcohol dependence is a gradual process, and it is often hard to notice it,” said Dr. Alexei B. Kampov-Polevoi, an assistant professor of psychiatry at Mount Sinai School of Medicine. “As a result, many alcoholics and their family members continue to think that a person ‘just drinks too much’ while this person already developed alcohol dependence and requires treatment.”

Whitfield and his colleagues examined statistics about alcohol use from three studies of Australian twins completed between 1980 and 1995. The number of twins in the studies declined from 8,184 in 1980 to 3,378 in 1995.

The findings appear in the August issue of Alcoholism: Clinical & Experimental Research.

The researchers found twins who were genetically similar were more likely to consume similar amounts of alcohol. According to the study, some genes affected both addiction and alcohol intake, while some just affected addiction.

“We found (as others have also found) that alcohol dependence is partly, but not entirely, due to genetic differences between people who are affected by it and those who are not,” Whitfield said. “We also found that variation in the amount of alcohol that people habitually drink is subject to genetic influence, and that there is some — but not complete — overlap between the genes affecting these two things.”

Howard J. Edenberg, professor of biochemistry and molecular biology at Indiana University, said the findings — that genes separately affect alcoholism and drinking — are “reasonable.” But “that is a long way from identifying individual genes that actually are involved,” said Edenberg, whose own research is looking into that area.

So what should ordinary folks take from this study? “There is no direct and new message for people with alcoholism in their families; they are at higher risk than average but this has been known for some time and there is only a statistical risk, not a certainty by any means,” Whitfield said. “The more positive message for such people, and the community at large, is that we are learning more about alcohol use and alcohol-related problems and their causes.”

Source: Randy Dotinga,HealthDay Reporter August 2004

More people have sought government-funded help for alcohol dependence and cannabis abuse than for any other addiction, a new report shows.

The Australian Institute of Health and Welfare (AIHW) report found 38 per cent of those who sought publicly-funded alcohol and drug treatment services in 2003/04, were getting help for alcohol-related problems.

Some 22 per cent sought help for cannabis abuse, with 18 per cent for heroin and 11 per cent for amphetamines.

The report revealed many people sought treatment for multiple drug problems, with more than half of all treatment sessions involving more than one substance.

AIHW report co-author Chrysanthe Psychogios said the report highlighted significant differences between age groups.

“It seems that there are ages and stages when it comes to seeking drug treatment services,” Ms Psychogios said in a statement She said cannabis and heroin were among drugs the under 30s sought help for. Alcohol was a major concern for those over 30s.

“For example, among 10-19 year olds, cannabis was the principal drug of concern in 49 per cent of treatment episodes, while in the 20-29 age group, cannabis at 27 per cent was closely followed by heroin at 26 per cent,” Ms Psychogios said.

<>Alcohol was the most commonly reported principal drug of concern for 30-39 year olds (40 per cent), rising to 82 per cent for those aged 60 and older, the report found.
In relation to amphetamines, almost half of users who sought help were aged 20-29.

“Among clients seeking treatment for amphetamines, injection was found to be the most common method of drug use at 79 per cent,” Ms Psychogios said.

The report also found men were more than twice as likely to receive treatment for amphetamine use than were women. Counselling and detoxification programs were among the most common types of treatment, with counselling favoured by women, as well as older clients.

The report examined 137,000 treatment sessions across 622 government-funded agencies.

Source: TheAge.com.au Aug l8th 2005

New research shows that more than half of deaths from liver disease in Jersey, some 52%, are alcohol-related.

It also suggests 70% of cases seen by medical staff every weekend in Jersey Hospital’s Accident and Emergency department are also linked to alcohol.

The new research is being gathered as part of the States’ five-year Alcohol Strategy to tackle the problem.

Michael Gafour, director of Jersey’s Alcohol and Drug Service, said people drank twice as much as those in the UK.  He also said that 7% of the island’s population was dependent on alcohol. He called for younger people to be educated about the dangers.