To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, May 24, 2008

Long-Term Stability and Heritability of Telephone Interview Measures of Alcohol Consumption and Dependence
Twin Research and Human Genetics Vol 11 Issue 3 June 2008 pp. 287-305

Alcohol dependence symptoms and consumption measures were examined for stability and heritability. Data were collected from 12,045 individuals (5376 twin pairs, 1293 single twins) aged 19 to 90 years in telephone interviews conducted in three collection phases. Phases 1 and 2 were independent samples, but Phase 3 targeted families of smokers and drinkers from the Phase 1 and 2 samples.

The stability of dependence symptoms and consumption was examined for 1158 individuals interviewed in both Phases 1 and 3 (mean interval = 11.0 years). For 1818 individuals interviewed in Phases 2 and 3 (mean interval = 5.5 years) the stability of consumption was examined. Heritability was examined for each collection phase and retest samples from the selected Phase 3 collection. The measures examined were a dependence score, based on DSM-IIIR and DSM-IV criteria for substance dependence, and a quantity × frequency measure.

Measures were moderately stable, with test–retest correlations ranging from .58 to .61 for dependence and from .55 to .64 for consumption.

However, the pattern of changes over time for dependence suggested that the measure may more strongly reflect recent than lifetime experience.

Similar to previous findings, heritabilities ranged from .42 to .51 for dependence and from .31 to .51 for consumption. Consumption was significantly less heritable in the younger Phase 2 cohort (23–39 years) compared to the older Phase 1 cohort (28–90 years).

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Threats to public health

May 24, 2008

The World Health Assembly (WHA) in Geneva, Minister of Health, Dr Leslie Ramsammy, who assumed the presidency of the WHA on Monday, in his speech, called on the World Health Organisation, (WHO) to tackle domestic violence and sexual abuse, particularly of young children. At the same forum, the WHO later announced that it would draw up a global strategy to tackle youth binge drinking and other forms of harmful alcohol consumption blamed for 2.3 million deaths a year.

These issues, along with cigarette smoking (nicotine addiction), the abuse of hard and prescription drugs and other substances and obesity constitute serious threats to public health and are being recognized as such. WHO assistant director-general for non-communicable diseases and mental health, Dr Ala Alwan, said at the forum that the harmful use of alcohol causes serious public health problems.

The devastating effect domestic and sexual violence has on the world’s human resources is not always immediately visible. However, sufficient studies have been done worldwide, which show that these social ills contribute to poor mental health, lead to addictions and can ultimately increase the numbers of orphans.

Youth binge drinking has been on the rise around the world leading to death by alcohol poisoning and mainly through traffic accidents. Then there is the correlation between alcohol abuse and violence – domestic, sexual and personal. Indeed, if the WHO is to tackle domestic and sexual violence effectively it would need to look at all contributory factors, and alcoholism, while it is not the only causative issue, is a major contributor.

The largest forum of health ministers in the world have since agreed that the strategy, which should be ready in two years would take into account national, religious and cultural contexts and would include recommended national measures such as guidance on the marketing, pricing, and distribution of alcoholic drinks and public awareness campaigns.
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Patterns of Alcohol Consumption and Related Behaviour in Great Britain: A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT)
Alcohol and Alcoholism Advance Access published online on May 22, 2008

Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples.

Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes.

Six classes best described responses in the sample data. Three were heavy consumption groups, one with multiple negative consequences, one experiencing alcohol-related injury and social pressures to cut down and an additional class with memory loss. There was one moderate class with few negative consequences, and finally two mild consumption groups, one with alcohol-related injury and social pressure to cut down and one with no associated problems.

Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not. Differences between alcohol use classes are apparent with reduced risk of depressive episode in moderate classes and an increased risk of anxiety disorders for the highest consumers of alcohol.

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HDL2 of Heavy Alcohol Drinkers Enhances Cholesterol Efflux From Raw Macrophages via Phospholipid-Rich HDL2b Particles
Alcoholism: Clinical and Experimental Research Volume 32 Issue 6 Page 991-1000, June 2008

Alcohol consumption is associated with increased serum high density lipoprotein (HDL) cholesterol levels and a decreased risk for the development of atherosclerosis. However, the effects of heavy alcohol intake on reverse cholesterol transport, one of the key anti-atherogenic processes related to HDL, are poorly known.

The ability of total HDL as well as HDL2 and HDL3 subclasses to promote cholesterol efflux from 3H-cholesterol-labeled RAW 264.7 macrophages was studied among 6 heavy alcohol drinkers and 6 controls. Distribution of HDL subclasses was analyzed by 4 to 30% native gradient gels. Serum phospholipid transfer protein (PLTP) and cholesteryl ester transfer protein (CETP) activities were analyzed among several other biochemical measures.

Cholesterol efflux to HDL2 of heavy drinkers was 22% (p = 0.025) higher relative to controls. The increase in HDL2 phospholipids, with a concomitant 2-fold (p = 0.055) increase in large HDL2b particles, was associated with enhanced cholesterol efflux to HDL2. Interestingly, the cholesterol efflux to HDL3 did not differ between the 2 study groups. These findings may be partially explained by a decreased CETP activity (−26%, p = 0.037) and an increased PLTP activity (39%, p = 0.045) in heavy drinkers.

The increased cholesterol efflux potential of HDL2 is most likely an anti-atherogenic feature linked to heavy alcohol consumption. The cholesterol efflux and HDL phospholipids also associated strongly within the whole study group (rs = 0.910, p ≤ 0.01) suggesting a common pathway of enhanced cholesterol efflux via enlarged phospholipid-rich HDL particles.

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Use of baseline and updated information on alcohol intake on risk for breast cancer: importance of latency
International Journal of Epidemiology,
IJE Advance Access published online on April 4, 2008

Alcohol intake has been shown to be associated with an increased risk for breast cancer. In the analysis of longitudinal prospective cohort studies, however, the analysis of repeated measurements of alcohol intake might not be straightforward.

The association between alcohol intake at first measurement (baseline alcohol intake) and breast cancer was positive and approximately linear. When alcohol intake was updated during follow-up, no association was observed between breast cancer and alcohol intake. It is suggested that this difference in results may be attributable to long latency time between alcohol intake and breast cancer occurrence, because a markedly increased risk was estimated on the basis of direct lagging of risk time.

Our results support the hypothesis that baseline alcohol intake is more strongly associated with breast cancer risk than updated intake, and we suggest that this is due to the long latency between alcohol intake and breast cancer.

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Friday, May 23, 2008

Association Between Alcohol Consumption and Both Osteoporotic Fracture and Bone Density
The American Journal of Medicine Volume 121, Issue 5, May 2008, Pages 406-418

Alcoholism is a risk factor for osteoporotic fractures and low bone density, but the effects of moderate alcohol consumption on bone are unknown. We performed a systematic review and meta-analysis to assess the associations between alcohol consumption and osteoporotic fractures, bone density and bone density loss over time, bone response to estrogen replacement, and bone remodeling.

We pooled effect sizes for 2 specific outcomes (hip fracture and bone density) and synthesized data qualitatively for 4 outcomes (non-hip fracture, bone density loss over time, bone response to estrogen replacement, and bone remodeling). Compared with abstainers, persons consuming from more than 0.5 to 1.0 drinks per day had lower hip fracture risk (relative risk = 0.80 [95% confidence interval, 0.71-0.91]), and persons consuming more than 2 drinks per day had higher risk (relative risk = 1.39 [95% confidence interval, 1.08-1.79]). A linear relationship existed between femoral neck bone density and alcohol consumption.

Because studies often combined moderate and heavier drinkers in a single category, we could not assess relative associations between alcohol consumption and bone density in moderate compared with heavy drinkers.

Compared with abstainers and heavier drinkers, persons who consume 0.5 to 1.0 drink per day have a lower risk of hip fracture. Although available evidence suggests a favorable effect of alcohol consumption on bone density, a precise range of beneficial alcohol consumption cannot be determined.

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Staggering Toward a Global Strategy on Alcohol Abuse
Science 16 May 2008: Vol. 320. no. 5878, pp. 862 - 863

David Grimm

Alcohol is about to get the type of attention usually reserved for AIDS and malaria. Next week, the World Health Organization (WHO) in Geneva, Switzerland, will take steps toward launching the first global assault on the harms associated with drinking. It’s a bold move, but it may not be bold enough. Although recent data indicate that alcohol abuse is a major killer worldwide, some experts feel that objections from member states and the involvement of the alcohol industry have weakened a resolution intended to kick-start a WHO-led offensive. Others wonder whether WHO has the resources to make such a strategy effective—or whether the agency should be focusing on other problems.

“A resolution is all very well, but it still takes a substantial commitment … for this to be translated into a substantial and lasting program of work,” says Robin Room, an alcohol policy expert at the University of Melbourne in Australia and a long-term observer of WHO.

This isn’t the first time WHO has flirted with an alcohol strategy. In 1983, the agency called on member states to strengthen their national alcohol policies—emphasizing a regional rather than global approach to the problem—but the words “fell on stony ground,” says Room.

“Alcohol has been a politically touchy thing for WHO to deal with,” Room notes, saying that the United States threatened to withhold funds from WHO in the 1980s if it pursued policies hostile to private enterprise. For a time, alcohol “dropped off WHO’s agenda.”

Then came WHO’s World Health Report 2002. Drawing on various studies, including WHO’s Global Burden of Disease project, the report concluded that alcohol was the fifth leading cause of death and disability worldwide. It beat out sanitation problems and high cholesterol and ranked just behind malnutrition and unsafe sex. Alcohol was as dangerous as tobacco, the report found—the source of up to 30% of various cancers and neurological disorders, and it had significant secondary dangers as well, leading to high rates of spousal abuse and homicide. Most devastating, however, was the conclusion that alcohol was the top cause of ill health and premature death in several developing countries, such as Brazil and Indonesia, and that—thank to rising incomes—things were only going to get worse. “It was a significant wake-up call,” says Peter Anderson, a public health expert previously with WHO, who currently advises the European Commission and other agencies on alcohol policy.

The report was the final straw for Finland. Having reduced liquor taxes to stay competitive with cheap Estonian imports, the country had seen a spike in alcoholrelated deaths. In 2005, Finland banded together with other Nordic countries, including Sweden and Norway, and presented a resolution to the World Health Assembly, WHO’s governing body, calling for a united effort to reduce alcohol-related health problems. “We wanted to see if a global strategy was possible,” says Bernt Bull, senior adviser at the Ministry of Health and Care Services in Norway and a member of the Norwegian delegation.

The resolution passed but quickly ran into trouble. The United States favored a voluntary strategy and called for more input from the alcohol industry. Thailand objected that the resolution didn’t go far enough and opposed industry involvement. And when WHO reconvened on the issue in May 2007, the drink trade had a new champion: Cuba. “The alcohol industry gives work and contributes to economic growth,” Oscar León Gonzalez of Cuba’s foreign affairs department told the Swedish newspaper Svenska Dagbladet at the time. He also said poorer countries had bigger problems: “Many countries cannot understand why [the Nordic countries] push the alcohol question so hard when people lie dying of AIDS, tuberculosis, and malaria.” The resolution died, but a few months later two of these poorer countries, Rwanda and Kenya, resurrected it in the form of a similarly worded resolution, effectively deflating León Gonzalez’s argument. “Alcohol causes a disproportionate burden of harm in poorer countries,” says Anderson, noting that people in these regions are likely to have more serious health risks and have less access to treatment. At the same time, the potential for harm is on the rise in countrie like India as people get a bit more money in their pockets.

“They’re going to start developing the same [alcohol-related] problems we had 50 years ago,” notes Ralph Hingson of the U.S. National Institute on Alcohol Abuse and Alcoholism in Bethesda,
Maryland. Hingson argues that WHO could help prevent a tragic repetition of this experience.

Buoyed by Africa’s involvement, the resolution won wide support from WHO’s executive board. Next week, member states are scheduled to vote at the World Health Assembly, and the measure is expected to pass. As written, the resolution directs the WHO director general to formulate a global alcohol strategy within 2 years. WHO’s final plan would not be legally binding but could include recommendations such as increasing alcohol taxes and banning certain types o liquor advertisements, as well as helping developed countries implement prevention strategies. A global approach is needed, says Anderson, because the alcohol trade crosses borders and because nations can learn from each other’s efforts. “You can’t just rely on a single country’s response.”

Despite its new momentum, however, the plan could run aground. Changes to the resolution, introduced recently by Mexico— and supported by Cuba and the United States—compel WHO’s director general to collaborate with the alcohol industry in shaping its strategy. And that could produce a “weak and feckless policy,” says Derek Rutherford, chair of the London-based Global Alcohol Policy Alliance. “The industry tries to play down evidence-based factors that reduce alcohol consumption, such as taxes and advertising bans, and instead focuses on education, eventhough there’s no proof that education works,” he says.

On the contrary, taxes are often ineffective and can even backfire, driving consumers to dangerous home brews, especially in poorer countries, says Phil Lynch of the U.S.–based spirits company Brown- Forman, a member of the Global Alcohol Producers Group, which is consulting with WHO. The industry is not opposed to regulation, he says, it just wants to see a comprehensive approach. “We understand the products better than everyone else, … and we deserve a seat at the table.”

WHO also must contend with limited resources. “WHO has a lot of irons in the fire,” says Room, noting that WHO’s investment in alcohol programs has been “extremely small in comparison with the size of the problems.” And Ramanan Laxminarayan, an expert on global disease priorities at the Washington, D.C.– based think tank Resources for the Future, says it may be hard for WHO—and poorer countries— to justify interventions aimed at curbing dangerous drinking. Such interventions “are not good value for the money,” says Laxminarayan, noting that malaria interventions are up to 100 times more cost effective.

Laxminarayan agrees with other global disease experts, however, that WHO is doing the right thing. “Developing countries don’t always have the foresight to see that alcohol will be a big issue for them,” he says. “WHO can be very influential in this regard.” Hingson says developed countries could benefit as well. He notes, for example, that the U.S. Surgeon General has released more than 30 reports on tobacco but only two on the harms of alcohol. “We may think we’re way ahead, but there are a lot of lessons we can learn.”

Action urged to cut big rise in heavy drinking

· Hospital admissions more than double over 10 years
· Doctors' leader demands end to discount alcohol

  • The Guardian,
  • Friday May 23 2008

Tougher measures to discourage people from damaging their health through alcohol abuse were called for yesterday as official statistics showed that the number of hospital admissions caused by heavy drinking has more than doubled since 1995.

The British Liver Trust warned that alcohol-induced health problems could become out of control. "Measures taken to curb this worrying trend just aren't working so far, according to these statistics," said Alison Rogers, chief executive of the trust. "This is set to hit England hard over the following years because liver disease can take up to 10 years to develop."
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122nd Session EB122.R2
Agenda item 4.7 23 January 2008
Strategies to reduce the harmful use of alcohol

The Executive Board,

Having considered the report on strategies to reduce the harmful use of alcohol,1

RECOMMENDS to the Sixty-first World Health Assembly the adoption of the following resolution:

The Sixty-first World Health Assembly, Having considered the report on strategies to reduce the harmful use of alcohol and the further guidance on strategies and policy element options therein;

Reaffirming resolutions WHA32.40 on development of the WHO programme on alcohol related problems, WHA36.12 on alcohol consumption and alcohol-related problems: development of national policies and programmes, WHA42.20 on prevention and control of drug and alcohol abuse and WHA57.16 on health promotion and healthy lifestyles;

Recalling resolution WHA58.26 on public-health problems caused by harmful use of alcohol and decision WHA60(10);

Noting the report by the Secretariat presented to the Sixtieth World Health Assembly on evidence-based strategies and interventions to reduce alcohol-related harm, including the addendum on a global assessment of public health problems caused by harmful use of alcohol;2

Noting the second report of the WHO Expert Committee on Problems Related to Alcohol Consumption3 and acknowledging that effective strategies and interventions that target the general population, vulnerable groups, individuals and specific problems are available and should be optimally combined in order to reduce alcohol-related harm;

Mindful that such strategies and interventions must be implemented in a way that takes into account different national, religious and cultural contexts, including national public health problems, needs and priorities, and differences in Member States’ resources, capacities and capabilities;
. . . . . . .

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Provisional agenda item 11.10 20 March 2008

Strategies to reduce the harmful use of alcohol
Report by the Secretariat

24. The Health Assembly is invited to consider the draft resolution contained in resolution EB122.R2.

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61st World Health Assembly
Notes from Day 4: Thursday, 22 May 2008

Committee A

Reducing the harmful use of alcohol:
After noting that they had not reached a consensus last year, delegates to Committee A today approved a draft resolution calling upon WHO to produce a global strategy aimed at reducing the harmful use of alcohol. The resolution called upon WHO to present the global strategy to the World Health Assembly in 2010. Alcohol is the fifth leading risk factor for death and disability in the world and many Member States showed deep concern about the magnitude and complexity of alcohol related harm world wide and emphasized an urgent need for action to reduce harmful use of alcohol. With the goal of approving a resolution to reach consensus, amendments to the text were withdrawn and an agreement of the text was reached after a series of supportive comments. The resolution will now go before the full plenary for final approval.

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Thursday, May 22, 2008

The Cardiovascular Implications of Alcohol and Red Wine.
Therapeutic Review

American Journal of Therapeutics. 15(3):265-277, May/June 2008.

We reviewed the roles of both alcohol and red wine in cardiovascular disease by discussing key animal and human studies. Included are studies regarding alcohol's association with coronary heart disease and the proposed mechanisms of action of alcohol. Likewise, studies concerning red wine's cardiovascular benefit and the mechanisms of action of red wine are discussed. Lastly, we reviewed studies on the adverse effects of alcohol and the current consumption recommendations as stated by the American Heart Association.

Moderate alcohol consumption (<=2 drinks per day) is associated with a reduced risk of coronary heart disease. This is believed to occur through alcohol's antithrombotic properties and its ability to increase high-density lipoprotein levels.

It remains unclear whether polyphenol compounds in red wine make it an especially cardioprotective alcoholic beverage. These compounds are proposed to act by inhibiting low-density lipoprotein oxidation and thrombosis independently of alcohol.

Moderate alcohol consumption is not associated with any significant morbidity; however, three or more drinks per day is associated with hypertriglyceridemia, cardiomyopathy, hypertension, and stroke.

The American Heart Association does not recommend alcohol as a treatment approach and suggests that men drink no more than two drinks per day and women no more than one drink per day.

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More than 350 drink-driving cases in one weekend

By Minna Passi

So far, this year has proved to be no less moist behind the wheel than any other. Last weekend, Finnish police up and down the country picked up no fewer than 362 persons driving under the influence of alcohol or pharmaceuticals or both. Of these, 39 were drug- or medication-related cases. Just over 300 DUIs were recorded between 6 p.m. on Friday and 6 p.m. on Sunday.

The cases may have been different but the pattern was all too familiar.
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WHO gets nod to tackle harmful use of alcohol

Thu May 22, 2008

By Stephanie Nebehay

GENEVA (Reuters) - The World Health Organization (WHO) is set to draw up a global strategy to tackle youth binge drinking and other forms of harmful alcohol consumption blamed for 2.3 million deaths a year, officials said on Thursday.

"The harmful use of alcohol causes serious public health problems," said Dr. Ala Alwan, WHO assistant director-general for non-communicable diseases and mental health.

The health ministers said the WHO strategy to reduce harmful use of alcohol should be "based on all available evidence and existing best practices...taking into account different national, religious and cultural contexts."

The blueprint, to be presented in two years, should include a set of recommended national measures for states. These could cover guidance on the marketing, pricing, and distribution of alcoholic drinks and public awareness campaigns.

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Press Release - NHS hospital admissions specifically related to alcohol more than double in 12 years

Hospital admissions specifically related to alcohol have more than doubled in England since 1995, according to an NHS Information Centre report published today (May 22 2008).
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Statistics on Alcohol: England 2008

This statistical report presents a range of information on alcohol use and misuse which are drawn together from a variety of published sources and includes additional analysis undertaken by the NHS Information Centre for health and social care which is presented in a user friendly format. The report aims to present a broad picture of health issues relating to alcohol in England and covers topics such as drinking habits and behaviours among adults and school children, drinking related ill health and mortality, affordability of alcohol and alcohol related costs. Government plans and recommendations in this area are also summarised in the report.

Key facts:

Drinking among adults

  • in England in 2006, 72 per cent of men and 57 per cent of women reported drinking an alcoholic drink on at least one day in the week prior to interview. Twelve per cent of men and seven per cent of women reported drinking on every day in the previous week
  • in Great Britain in 2007, 69 per cent of people reported that they had heard of the government guidelines on alcohol consumption. Of these people, 40 per cent said that they did not know what the recommendations were.

Drinking among school children

In England in 2006, among pupils aged 11 to 15:

  • 45 per cent of pupils said they had never had a proper alcoholic drink (a whole drink and not just a sip), an increase compared to 39 per cent in 2001
  • 15 per cent of pupils thought it was okay to get drunk at least once a week, this figure was 30 per cent for 15 year olds.

Drinking-related ill-health and mortality

In England:

  • in 2007, there were 112,267 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings; an increase of 20 per cent since 2003 when there was 93,241 prescription items
  • in 2006/07, there were 57,142 NHS hospital admissions with a primary diagnosis specifically related to alcohol. This number has risen by 52 per cent since 1995/96. Of these admissions, 4,888 (nine per cent) involved patients under 18 years of age
  • in 2006/07, NHS hospital admissions per 100,000 population varied regionally throughout England. In 2006/07 the North West Strategic Health Authority had the highest rate of 170 admissions with a primary diagnosis specifically related to alcohol per 100,000 population, and the East of England Strategic Health Authority showed the lowest rate of 72 admissions per 100,000 population.

Profiles of Recovery Advocacy in Action

A Life of Service and Advocacy:
An interview with Johnny Allem by Bill White

Too often, someone of importance passes in the world of addiction treatment and recovery, and we realize that we never took the opportunity personally or as a community to acknowledge our respect and affection to them. One of my personal goals in this “Profiles of Recovery Advocacy in Action” series is to eulogize the living. That affords an opportunity to honor people for whom I have such respect and affection. I have a particular affinity for people whose lives stand as a living testimony of sustained service to others and to movements aimed at elevating the quality of human life. There are few people in the recovery advocacy movement whose lives more vividly exemplify the power of healing and hope than my friend Johnny Allem. Johnny has recently announced his retirement from the Johnson Institute. We wish him Godspeed on this important milestone in his life and offer him our deepest thanks for his sacrifices and his contributions. We also thank him for being one of the groundbreaking faces and voices of recovery before there was a Faces & Voices of Recovery.

In this February 26, 2008 interview and a follow-up conversation in early May 2008, Johnny reflects on his life and the movement that has touched so many of our lives.
. . . . . .

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Mixed response for alcohol policy

22 May 2008

The AFL wants its 16 clubs to sign on to a policy document on responsible drinking.

Instead of taking a proscriptive approach the draft policy, which was 18 months in the making, focuses on the welfare of footballers and workplace safety.

The AFL acknowledges that it's in its own best interests and the interests of grassroots football and the wider community that it establishes benchmarks for responsible drinking and reducing the harm associated with risky alcohol consumption.

Dr Pippa Grange is the general manager of psychology, people and culture with the AFL Players' Association.

"All 16 clubs now have to adhere to a compliance checklist that's based on the sets of principles and competencies that the policy describes," she told AM.

"So it sort of frames up a streamlined and standardised policy across the league."

Dr Grange has denied criticisms that there are too many loopholes for players.

"I'm a definite advocate of a harm minimisation and a welfare-oriented approach to issues such as drug and alcohol," she said.

"But more importantly, this is not just about players. This is a league-wide and an industry initiative so this encompasses AFL and AFLPA administrators and staff, coaches, umpires and players."

David Templeman, CEO of the Alcohol and Other Drugs Council, says the AFL should be credited with taking the issue seriously.

"On first reading, it's a very progressive step," he said.

"We have an issue in the community of alcohol-related harm and they are taking some very significant leadership steps to at least do something about it in their own organisation."

The draft defines risky alcohol consumption as between seven and 10 drinks a day, based on guidelines laid out in 2001.
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AFL sounds out clubs on drinking policy21 ay 2008

21 May 2008

THE AFL has asked its clubs for feedback on a policy to promote the responsible use of alcohol.

A draft policy created by the league and the AFL players' association will be sent to all clubs, with input also being sought from national drug and alcohol experts.

“The AFL, the Players' Association and our clubs understand that we have a responsibility to promote responsible drinking within the AFL and among the 16 clubs, the players and staff," league football operations manager Adrian Anderson said.

"This has been a work in progress for almost two years and the next step is to provide the draft version of the AFL Framing Policy to our key stakeholders for their views.

"The guidelines within the AFL Framing Policy will provide a framework for AFL clubs to assist them in developing their own individual club responsible alcohol policies, and provide leadership for other football leagues below the AFL."
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How First Nations People Cure Their Own Addictions

I partner with a recovered addict named Scott Gallagher in presenting addiction-prevention programs to high school kids and their parents. Last week we met in a far north region of British Columbia to present at a secondary school in an indescribably beautiful river valley where a group of First Nations People have several villages.

Substance abuse is rife. Some people believe the situation is actually worsening as young First Nation People seemingly become more alienated from the mainstream culture while being attracted to its darker and superficial (e.g., pop entertainment) values.

They are still searching for a balance between traditional cultural values and participaton in the white world. How do you strengthen family and community ties while arming young people to get constructively involved in the broader economy and culture?
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What can we learn from America?

Wednesday, 21 May 2008

Interesting to see Kathy Gyngell calling for us to look at the American system in helping people overcome substance use problems, following a visit to the States. Her Blog is well worth a read.

Kathy described the point made by one professional: “the recovery movement here is huge; we do not seem to make as big a deal about ‘abstinence’ versus ‘harm reduction’ as it seems the Europeans do.” She also described a programme that, ‘has significant freedom to decide its own methods and programmes. A far cry from the UK’s state directed hegemony.’

As I have pointed out in my DDN Briefings, the Americans are years ahead of us. We need to be following the example of their Recovery Movement. So few people in this country understand the concept of recovery, know the Faces & Voices of Recovery movement and website, or have heard of William L White (a new member of our Advisory Board) and his seminal work.

This needs to change – urgently. We need to stop protecting the inadequate system we have and start looking outward and forward. Keeping the good things that we have and accepting the achievements we have made.
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Capability of California's drug and alcohol treatment director questioned

By Jordan Rau, Los Angeles Times Staff Writer
May 22, 2008

A state watchdog commission is skeptical that Renée Zito, hired on the recommendation of Schwarzenegger's chief of staff, will be able to turn the 'weak' agency around.
SACRAMENTO -- -- A personal connection with Gov. Arnold Schwarzenegger's chief of staff led to Renée Zito's selection as California's drug and alcohol treatment czar. But more than a year into her tenure, Zito's aptitude is being questioned by substance abuse professionals and by an independent state watchdog agency.

Before she was tapped to run the California Department of Alcohol and Drug Programs, Zito was a top official at Marin Services for Women, a nonprofit treatment center in the San Francisco Bay Area, where she worked with the domestic partner of Susan Kennedy, Schwarzenegger's chief of staff. Kennedy's partner was promoted to Zito's job after she left.
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Wednesday, May 21, 2008

Transketolase: Observations in alcohol-related brain damage research
The International Journal of Biochemistry & Cell Biology Article in Press,
8 April 2008

Thiamin, or vitamin B1, is crucial for brain function. In its active form, thiamin pyrophosphate (TPP), it is a co-enzyme for several enzymes, including transketolase.

Transketolase is an important enzyme in the non-oxidative branch of the pentose phosphate pathway (PPP), a pathway responsible for generating reducing equivalents, which is essential for energy transduction and for generating ribose for nucleic acid synthesis. Transketolase also links the PPP to glycolysis, allowing a cell to adapt to a variety of energy needs, depending on its environment.

Abnormal transketolase expression and/or activity have been implicated in a number of diseases where thiamin availability is low, including Wernicke-Korsakoff's Syndrome and alcoholism.

Yet, the precise mechanism by which this enzyme is involved in the pathophysiology of these disorders remains controversial.

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Media Release - Kempsey Community tackles alcohol-related crime in April


Data from the Alcohol Action in Rural Communities (AARC) project shows that, historically, there has been a peak in alcohol-related crime in Kempsey around this time each April. Dr Anthony Shakeshaft, co-lead investigator on AARC, said that the crime data from 2001 to 2006 clearly showed that the weekend of the 12th and 13th April is high-risk for alcohol-related malicious damage, accounting for 49% of incidents in the month. The majority of which occurred in 2005 and 2006.

Statistics indicate that the second weekend in April is an opportune time to implement strategies aimed at reducing alcohol-related harm: “When the cost and social impact of these crimes on the community is considered, including the need for police, ambulance and hospital resources, there is clear scope for everyone to be more responsible in the use of alcohol,” said Dr Shakeshaft.
. . . . . . .

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Alcohol harm reduction strategy launch


Derby Community Safety Partnership, along with its partners Derby City Primary Care Trust and Derbyshire Constabulary, will today launch its Alcohol Harm Reduction Strategy.

The strategy sets out what actions and commitments will be taken forward in Derby to combat excessive alcohol use, specifically its impact on health, crime and disorder over the next three years.

Key aims in the strategy include;
• Triple the number of alcohol treatment places
• Provide education for every young person in Derby
• Reduce the number of alcohol-related incidents of disorder
• Reduce the number of alcohol-related violent crimes
• Contribute to saving 2,000 premature deaths over the ten years
• Support GPs in addressing alcohol use as part of primary care general health provision
• Develop specialist treatment services

The strategy is launched to coincide with the Government’s “Know Your Limits” campaign which highlights nationally that;
• NHS admissions for alcohol-related illness are rising fast year-on-year.
• Between 15,000 and 20,000 premature deaths in England and Wales each year are associated with alcohol misuse
• There are over 10 million people drinking above the Government’s lower-risk levels
• Most people drinking above lower risk levels are unaware of the potential health risks

Derby Community Safety Partnership Strategic Lead Mike Murray explained: “Alcohol misuse not only impacts upon individuals and their families, it is a common factor in crime, violence and anti social behaviour and is a major factor in poor health.

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Controversial 'alcopops' measure to become law

Bill allows fruit-flavored alcoholic drinks to be taxed at lower rate
Despite intense pressure from public health advocates and parents, Gov. Martin O'Malley announced Wednesday his support for a bill that ensures that popular flavored malt beverages would continue to be widely distributed and subject to a lower tax rate than other alcoholic drinks.

O'Malley said he would allow the bill to become law without his signature but signaled that he would pursue legislation to change the way "alcopops" are regulated during next year's General Assembly session. The Democratic governor had pulled back from signing the bill during a formal ceremony last month, but last night he announced that he would not veto the bill. His last formal bill signing is scheduled for today.
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Letter from Governor O’Malley to Senate President Thomas V. Mike Miller, Jr - Senate Bill 745

May 21, 2008

The Honorable Thomas V. Mike Miller, Jr.
President of the Senate
State House
Annapolis MD 21401

Dear Mr. President:

This year, the General Assembly – largely in response to the threat of a potential 16-fold increase in the tax rate that is currently being assessed on flavored malt beverages (“FMBs”)1 – overwhelmingly passed legislation to codify the decades-old practice of regulating and taxing FMBs as beer. 2

Today, I have made the difficult decision to allow Senate Bill 745 - Alcoholic Beverages - Definitions – Beer3 to go into effect without my signature pursuant to Article II, Section 17 of the Maryland Constitution. To understand my decision to allow this bill to go into effect without my signature, despite the concerns I and many others have about the problem of underage alcohol consumption, it is important to note what this bill does not do. This bill does not define FMBs as a separate category of alcohol. Nor does this bill change our statutory law to “downgrade” the status of FMBs from distilled spirits to beer, thereby reducing the cost of FMBs or making sales of FMBs more widely available.
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Press Release - Governor Martin O'Malley Vetoes Bill, Allows Others to Become Law without Signature

ANNAPOLIS, MD (May 21, 2008) – Governor Martin O’Malley allowed two bills to become law today without his signature, including a bill which formally defines flavored malt beverages as beer. In addition, Governor O’Malley vetoed one bill.

Governor O’Malley allowed the following bills to become law without his signature:

  • SB 251 / HB 303 – Anne Arundel County – Well Drillers – Permit Fee
  • SB 745 Alcoholic Beverages – Definitions – Beer

“While these bills today will become law in Maryland, the absence of my signature should indicate to the General Assembly that there is work left to be done,” said Governor O’Malley in announcing the decision today.

“In particular, I look forward to returning to the flavored malt beverage issue during the next legislative session, working with advocates on both sides, to build a broader consensus for regulating these alcoholic beverages. It is my opinion that the Constitution contemplates, and the public expects, major regulatory and taxation decisions of this nature to be made in the fullness of legislative consideration, not through the chance confluence of an opinion of the Attorney General and the veto of a Governor.”

“I will, therefore, be working with the Attorney General and interested parties in the upcoming Session of the Maryland General Assembly to build a broader consensus for regulating more effectively what many would rightly conclude is a fourth category of alcoholic beverages.”

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Impulsivity, age of first alcohol use and substance use disorders among male adolescents: a population based case-control study
Addiction Early Online 20 May 2008

To evaluate the association between impulsivity, age of first alcohol consumption (AFD) and substance use disorders (SUD) in a non-clinical sample of adolescents.

Impulsivity and AFD were significantly associated with SUD. Both higher impulsivity [odds rat (OR) 3.3, 95% confidence interval (CI) 1.4–7.8] and earlier AFD (OR 1.2, 95% CI 1.0–1.3) remained associated with SUD after model adjustments.

The findings from this population-based case–control study suggest that impulsivity and age of first alcoholic drink are associated strongly with alcohol and drug problems. Additionally, impulsivity seems to contribute to a premature exposure to alcohol by hastening the AFD. If the temporal effect of these associations is confirmed in longitudinal designs including broader population groups, our findings may contribute to the development of clinical and policy interventions aiming at reducing the incidence and morbidity associated with substance-related problems among adolescents.

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Are there genetic influences on addiction: evidence from family, adoption and twin studies
Addiction OnlineEarly Articles 20 May 2008

In this exciting era of gene discovery, we review evidence from family, adoption and twin studies that examine the genetic basis for addiction. With a focus on the classical twin design that utilizes data on monozygotic and dizygotic twins, we discuss support in favor of heritable influences on alcohol, nicotine, cannabis and other illicit drug dependence.

We review whether these genetic factors also influence earlier stages (e.g. experimentation) of the addictive process and whether there are genetic influences specific to each psychoactive substance.

Converging evidence from these studies supports the role of moderate to high genetic influences on addiction with estimates ranging from 0.30 to 0.70. The changing role of these heritable factors as a function of gender, age and cultural characteristics is also discussed. We highlight the importance of the interplay between genes and the environment as it relates to risk for addiction and the utility of the children-of-twins design for emerging studies of gene–environment interaction is presented.

Despite the advances being made by low-cost high-throughput whole genome association assays, we posit that information garnered from twin studies, especially extended twin designs with power to examine gene–environment interactions, will continue to form the foundation for genomic research.

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Review of Australian health economic evaluation- 245 interventions: what can we say about cost-effectiveness?
Cost Effectiveness and Resource Allocation 2008, 6:9

There is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy.

The median cost-effectiveness ratio was $18,100 (~US$13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively), than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at ~A$9,000 ~US$6,500).

Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost /QALY/DALY/ LY 25 years (median cost /QALY/DALY/ LY

For any given condition, modality or setting there are likely to be examples of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the individual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit.

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The role of alcohol in women's lives: a review of issues and responses
Journal of Substance Use, Volume 13, Issue 3 June 2008 , pages 155 - 191

This review addresses some of the issues related to women's drinking at a time when this is extremely topical.

Evidence suggests that there has been a marked increase in alcohol consumption amongst young women in the United Kingdom (UK). Teenage girls have even been shown to be engaging in 'binge' or 'heavy episodic' drinking more than their male counterparts. Levels of adverse effects, such as liver disease and psychiatric hospital admissions amongst young women have been increasing.

Some of the factors associated with these changes are considered. These include changing social roles, feminism, gender stereotypes, occupation and advertising. Some of the powerful positive effects associated with the consumption of beverage alcohol are considered, together with the adverse consequences. The latter include both acute consequences, such as intoxication, injuries and accidents, as well as long-term or chronic consequences, such as liver disease, cancer and alcohol dependence.

This review also describes some of the available evidence related to treatment for alcohol problems amongst women including special populations, relapse and the issue of professional training. Finally, the implications for both alcohol control policy and research into alcohol-related issues are considered.

It is concluded that existing UK alcohol policies are not fully evidence based. Moreover, research into beverage alcohol in the UK is severely under-funded.

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Ordered subsets linkage analysis of antisocial behavior in substance use disorder among participants in the collaborative study on the genetics of alcoholism
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics
Published online 21 May 2008

Heterogeneity in complex diseases such as Substance Use Disorder (SUD) reduces the power to detect linkage and makes replication of findings in other populations unlikely.

It is therefore critical to refine the phenotype and use methods that account for genetic heterogeneity between families.

SUD was operationalized as diagnosis of abuse or dependence to alcohol and/or any one of five illicit substances. Whole-genome linkage analysis of 241 extended pedigree families from the Collaborative Study on the Genetics of Alcoholism was performed in Merlin using an affected sibship design. An Ordered Subsets Analysis (OSA) using FLOSS sought to increase the homogeneity of the sample by ranking families by their density of childhood and adult antisocial behaviors, producing new maximum Nonparametric Lod (NPL) scores on each chromosome for each subset of families.

Prior to OSA, modest evidence for linkage was found on chromosomes 8 and 17. Although changes in NPL scores were not statistically significant, OSA revealed possible evidence of linkages on chromosome 7, near markers D7S1795 and D7S821. NPL scores >3.0 were also observed on chromosomes 2, 3, 5, 9, and 14. However, the number of families used in these latter subsets for linkage may be too small to be meaningful.

Results provide some evidence for the ability of OSA to reduce genetic heterogeneity, and add further support to chromosome 7 as a possible location to search for genes related to various SUD related processes. Nonetheless, replication of these results in other samples is essential.

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Dual diagnosis in Manchester, UK: practitioners' estimates of prevalence rates in mental health and substance misuse services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 2 June 2008 , pages 118 - 124

Dual diagnosis (the combination of mental health and drug/alcohol problems) has been recognized as a major health concern. Most studies in this field stem from the US and information about dual diagnosis prevalence is limited in the UK.

To obtain estimates of dual diagnosis prevalence rates across mental health and substance misuse services in Manchester.

Telephone interviews were carried out with team managers of mental health (n = 24) and substance misuse services (n = 9).

The mean percentage of dual diagnosis clients throughout services was 46%. The highest proportions were identified in the assertive outreach team (71%), followed by substance use services (59%), and psychiatric inpatient wards (56%). The acute home treatment team (12%) reported the lowest estimate of clients with dual diagnosis problems.

Service providers perceived dual diagnosis to be of major concern across mental health and substance misuse services in Manchester. The estimates were considerably higher than previously reported prevalence rates.

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Modest wine drinking and decreased prevalence of suspected nonalcoholic fatty liver disease
Hepatology Published Online: 21 Feb 2008

People at risk for coronary heart disease are often at risk for nonalcoholic fatty liver disease (NAFLD). The association of modest wine consumption with NAFLD has not been studied and the recommendation of wine for patients at risk for both diseases is controversial.

The aim is to test the hypothesis that modest wine consumption is associated with decreased prevalence of NAFLD. We included Third National Health and Nutrition Examination Survey participants who either reported no alcohol consumption or preferentially drinking wine with total alcohol consumption up to 10 g per day. Suspected NAFLD was based on unexplained serum alanine aminotransferase (ALT) elevation over the cut point of the reference laboratory (ALT > 43) and the cut point based on the 95th percentile of healthy subjects (ALT > 30 for men; ALT > 19 for women). Multivariate analysis was adjusted for age, gender, race, neighborhood, income, education, caffeine intake, and physical activity. A total of 7,211 nondrinkers and 945 modest wine drinkers comprised the study sample.

Based on the reference laboratory cut point, suspected NAFLD was observed in 3.2% of nondrinkers and 0.4% of modest wine drinkers. The adjusted odds ratio was 0.15 (95% confidence interval, 0.05-0.49). Using the healthy subject cut point, suspected NAFLD was observed in 14.3% of nondrinkers and 8.6% of wine drinkers. The adjusted odds ratio was 0.51 (95% confidence interval, 0.33-0.79).

Modest wine consumption is associated with reduced prevalence of suspected NAFLD. The current study supports the safety of one glass of wine per day for cardioprotection in patients at risk for both coronary heart disease and NAFLD.

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Genetic Dissociation of Ethanol Sensitivity and Memory Formation in Drosophila melanogaster
Genetics, Vol. 178, 1895-1902, April 2008,

The ad hoc genetic correlation between ethanol sensitivity and learning mechanisms in Drosophila could overemphasize a common process supporting both behaviors.

To challenge directly the hypothesis that these mechanisms are singular, we examined the learning phenotypes of 10 new strains. Five of these have increased ethanol sensitivity, and the other 5 do not.

We tested place and olfactory memory in each of these lines and found two new learning mutations. In one case, altering the tribbles gene, flies have a significantly reduced place memory, elevated olfactory memory, and normal ethanol response. In the second case, mutation of a gene we name ethanol sensitive with low memory (elm), place memory was not altered, olfactory memory was sharply reduced, and sensitivity to ethanol was increased.

In sum, however, we found no overall correlation between ethanol sensitivity and place memory in the 10 lines tested. Furthermore, there was a weak but nonsignificant correlation between ethanol sensitivity and olfactory learning.

Thus, mutations that alter learning and sensitivity to ethanol can occur independently of each other and this implies that the set of genes important for both ethanol sensitivity and learning is likely a subset of the genes important for either process.

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Drugs and alcohol: Alcohol stories

Four young people talk about their personal experiences with alcohol

Wednesday May 21, 2008

This programme, aimed at KS3/4, focuses on four young people, each with a story to tell about their personal experience of alcohol, and how it can change a person's life.

Marcio arrived from Angola with his grandmother three years ago; following her death he turned to drink, looking to forget his problems. Tasha contracted a sexually transmitted infection after drinking too much at a party. Curtis damaged his chances for a career as a professional snooker player by drinking too much and Becky struggled with alcoholism through her teenage years.

All of them have learned from their experience, and have something to offer to the viewers of Alcohol Stories.

Watch the video now in Quicktime or RealPlayer or Windows Media Player.

Click here to subscribe to this and future episodes via iTunes, or here for the RSS feed.


Underage Drinking

30% of 16 year olds are regularly getting drunk - Knowing the facts about alcohol and how to talk to young people about alcohol can help to prevent the harm that teenage alcohol use can cause. Visit the HSE's Health Promotion Site to read more about Underage Drinking

HSE launches new Alcohol Awareness Campaign

19th May 2008:

The Health Service Executive has launched a new alcohol awareness campaign aimed at delaying the age at which young people start to drink.

The HSE Alcohol Awareness Campaign features a thought provoking television advertisement, depicting a number of young people in a variety of situations where they are exposed to and gain access to alcohol. The aim of the campaign is to increase awareness in adults about the extent of underage drinking, the ease of access which young people have to alcohol and the benefits in delaying the age at which young people start to drink.
The campaign has been launched as preliminary results of research carried out by the HSE reveal that:

  • 91% of adults agree that underage drinking is a problem in Ireland today
  • 50% of those questioned believe there is nothing they can do to stop young people from drinking alcohol
  • Just 15% believed their own drinking habits influence the drinking habits of young people around them
  • 81% of those questioned believe that it's easy for under 18's to access alcohol in pubs and off licences
  • Just 40% of those questioned would drink less if they thought it would discourage young people around them from drinking alcohol . . . . . . .
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