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, January 9, 2010
Alcohol reverses depressive and pronociceptive effects of chronic stress in mice with enhanced activity of the opioid system
The role of the opioid system in mediating effects of alcoholism and stress in depression is far from clear.
We studied, therefore, the effects of chronic mild stress (CMS) and alcohol drinking on depression-like behavior and nociception in lines of mice selected for high (HA) or low (LA) swim stress-induced analgesia.
Compared to the LA mice, the HA animals display up-regulation of opioid receptor system function and depression-like behavior in tail suspension test (TST).
We report now that alcohol reverses depressive and pronociceptive effect of CMS in HA mice. In contrast, in LA mice CMS does not affect nociception or behavior in TST and the animals are not susceptible to alcohol under CMS.
The results suggest that opioid system activity may determine the effects of alcohol on behavior under stress and, therefore, link predispositions to depression and to alcoholism.
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Alcohol Consumption, Serum Gamma-Glutamyltransferase, and Helicobacter Pylori Infection in a Population-Based Study Among 9733 Older Adults
Moderate alcohol consumption has been suggested to facilitate the elimination of Helicobacter pylori infection as the result of its antibacterial effect.
We aimed to assess the associations of current and lifetime alcohol consumption as well as serum gamma-glutamyltransferase (GGT), an established biomarker of alcohol consumption, with H. pylori infection in a large population-based study.
A significant inverse association, in dose-response manner, was observed between both current and lifetime alcohol consumption and H. pylori seropositivity. The estimates based on lifetime consumption were more pronounced than the results for current consumption, and such inverse associations were found both for men and women. Stronger relations were observed for those who only drank wine or mixed drinkers compare with those who only drank beer. Furthermore, there was a significant inverse dose-response relationship between serum GGT levels and H. pylori seropositivity, which was selectively observed among alcohol drinkers.
In conclusion, our results support the hypothesis that moderate alcohol consumption may facilitate elimination of H. pylori.
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The Los Angeles Times notices that people can overcome drinking problems without abstaining from alcohol for the rest of their lives. More important, the Times quotes Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, who admits that the one-size-fits-all, abstinence-only approach preached by Alcoholics Anonymous is inconsisent with the evidence on drinking patterns (emphasis added): . . . . .
Friday, January 8, 2010
Nick references David Davies, the Sobells and Australian work on controlled drinking treatment. Nick talks about how his interest in this topic was sparked, the book he wrote with Ian Robertson on this topic and the early trial of controlled drinking treatment they carried out.
Nick talks about the work of Mansell Pattison in the 1970s of ‘attenuated drinking’ and makes other points about the goals of controlled drinking and moderation. “It’s when you extend that principle (of harm reduction) to everybody, I think, that you get the problems.”
Every industry carefully plans how to advance its business agenda and counter threats to profitability. What makes industries change the strategies they use to respond to public pressure to modify health damaging practices? Do announced changes in practice reflect real change or are they simply old wine in new bottles?
In this report, Corporations and Health Watch analyzes changes in alcohol industry responses to criticisms of its marketing practices.
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A greater reduction in cardiovascular risk and vascular protection associated with diet rich in polyphenols are generally accepted; however, the molecular targets for polyphenols effects remain unknown. Meanwhile evidences in the literature have enlightened, not only structural similarities between estrogens and polyphenols known as phytoestrogens, but also in their vascular effects. We hypothesized that alpha isoform of estrogen receptor (ERα) could be involved in the transduction of the vascular benefits of polyphenols.
This study provides evidence that red wine polyphenols, especially delphinidin, exert their endothelial benefits via ERα activation. It is a major breakthrough bringing new insights of the potential therapeutic of polyphenols against cardiovascular pathologies.
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Over the last 60 years English drinking habits have been transformed. In 1947 the nation consumed approximately three and a half litres of pure alcohol per head; the current figure is nine and a half litres. According to the General Household Survey data from 2006, 31% of men are drinking hazardously (more than 21 units per week) or harmfully (more than 50 units) of whom 9% are drinking harmfully. 21% of women are drinking hazardously or harmfully of whom 6% are drinking harmfully. While the consumption of alcohol has increased, taxation on spirits has declined in real terms and even more so as a fraction of average earnings.
The rising levels of alcohol consumption and their consequences have been an increasing source of concern in recent years. These involve not only the consequences of binge drinking which are a cause of many serious accidents, disorder, violence and crime, but also long term heavy drinking which causes more harm to health. The President of the Royal College of Physicians told us that alcohol was probably a significant factor in 30 to 40,000 deaths per year. The WHO has put alcohol as the third most frequent cause of death after hypertension and tobacco. UK deaths from liver cirrhosis increased more than five fold between 1970 and 2006; in contrast in France, Italy and Spain the number of deaths shrank between two and four fold; this country's deaths from cirrhosis are now above all of them.. In 2003 the P M's Strategy Unit estimated the total cost of alcohol to society to be £20 bn; another study in 2007 put the figure at 55 bn.
Faced by a mounting problem, the response of successive Governments has ranged from the non-existent to the ineffectual. In 2004 an Alcohol Strategy was published following an excellent study of the costs of alcohol by the Strategy Unit. Unfortunately, the Strategy failed to take account of the evidence which had been gathered.
The evidence showed that a rise in the price of alcohol was the most effective way of reducing consumption just as its increasing affordability since the 1960s had been the major cause of the rise in consumption. We note that minimum pricing is supported by many prominent health experts, economists and ACPO. We recommend that the Government introduce minimum pricing.
There is a myth widely propagated by parts of the drinks industry and politicians that a rise in prices would unfairly affect the majority of moderate drinkers. But precisely because they are moderate drinkers a minimum price of for example 40p per unit would have little effect. It would cost a moderate drinker 11p per week; a woman drinking the recommended maximum of 15 units could buy her weekly total of alcohol for £6.
Opponents also claim that heavier drinkers are insensitive to price changes, but as a group their consumption will be most affected by price rises since they drink so much of the alcohol purchased in the country. Minimum pricing would most affect those who drink cheap alcohol, in particular young binge-drinkers and heavy low income drinkers who suffer most from liver disease. It is estimated that a minimum price of 50p per unit would save over 3,000 lives per year, a minimum price of 40p, 1,100 lives.
Minimum pricing would have other benefits. Unlike rises in duty minimum pricing would benefit traditional pubs which sell alcohol at more than 40p or 50p per unit; unsurprisingly it is supported by CAMRA. Minimum pricing would also encourage a switch to weaker wines and beers. With a minimum price of 40p per unit, a 10% abv wine would cost a minimum of £2.80p, a 13% abv. wine £3.60p.
However, without an increase in duty minimum pricing would lead to an increase in the profits of supermarkets and the drinks industry. Alcohol duty should continue to rise year on year, but unlike in recent years duty increases should predominantly be on stronger alcoholic drinks, notably on spirits. The duty on spirits was 60% of male average manual weekly earnings in 1947; in 1973 (when VAT was imposed in addition to duty) duty was 16% of earnings; by in 1983 it was 11% and by 2002 it had fallen to 5%. We recommend that the duty on spirits be returned in stages to the same percentage of average earnings as in the 1980s. The duty on industrial white cider should also be increased. Beer under 2.8% can be taxed at a different rate and we recommend that the duty on this category of beer be reduced.
An increase in prices must be part of a wider policy aimed at changing our attitude to alcohol. The policy must be aimed at the millions who are damaging their heath by harmful drinking, but it is also time to recognise that problem drinkers reflect society's attitude to alcohol. There is a good deal of evidence to show that the number of heavy drinkers in a society is directly related to average consumption. Living in a culture which encourages drinking leads more people to drink to excess. Changing this culture will require a raft of policies.
Education, information campaigns and labelling will not directly change behaviour, but they can change attitudes and make more potent policies more acceptable. Moreover, people have a right to know the risks they are running. Unfortunately, these campaigns are poorly funded and ineffective at conveying key messages; people need to know the health risks they are running, the number of units in the drink they are buying and the recommended weekly limits, including the desirability of having two days drink-free each week. The information should be provided on the labels of alcohol containers and we recommend that all alcohol drinks containers should have labels containing this information. We doubt whether a voluntary agreement, even if it is possible to come to one, would be adequate. The Government should introduce a mandatory labelling scheme.
Expenditure on marketing by the drinks industry was estimated to be c. £600-800m in 2003. The current system of controls on alcohol advertising and promotion is failing the young people it is intended to protect. Both the procedures and the scope need to be strengthened. The regulation of alcohol promotion should be completely independent of the alcohol and advertising industries; this would match best practice in other fields such as financial services and professional conduct. In addition, young people should themselves be formally involved in the process of regulation: the best people to judge what a particular communication is saying are those in the target audience.
The current controls do not adequately cover sponsorship or new media which are becoming increasingly important in alcohol promotion. The codes must be extended to address better sponsorship. New media presents particular regulatory challenges, including the inadequacy of age controls and the problems presented by user generated content. Expert guidance should be sought on how to improve the protection offered to young people in this area. Finally, there is a pressing need to restrict alcohol advertising and promotion in places where children are likely to be affected by it.
Alcohol-related crime and anti-social behaviour have increased over the last 20 years, partly as a result of the development of the night time economy with large concentrations of vertical drinking pubs in town centres. The DCMS has shown extraordinary naivety in believing the Licensing Act 2003 would bring about 'civilised cafe culture'. In addition, the Act has failed to enable the local population to exercise adequate control of a licensing and enforcement regime which has been too feeble to deal with the problems it has faced. Some improvements have been made through the Policing and Crime Act 2009, in particular the introduction of mandatory conditions on the sale of alcohol. We urge the Government to implement them as a matter of urgency, but problems remain. It is of concern that section 141 of the Licensing Act 2003is not enforced and we call on the police to enforce it.
The 2009 Act has made it easier to review licences, giving local authorities the right to instigate a review. We support this. However, we are concerned that local people will continue to have too little control over the granting of licences and it will remain too difficult to revoke the licences of premises associated with heavy drinking. The Government should examine why the licences of such premises are not more regularly revoked.
In Scotland legislation gives licensing authorities the objective of promoting public health. Unfortunately, public health has not been a priority for DCMS. We recommend that the Government closely monitor the operation of the Scottish licensing act with a view to amending the Licensing Act 2003 to include a public health objective.
The most effective way to deal with alcohol related ill-health will be to reduce overall consumption, but existing patients deserve good treatment and a service as good as that delivered to users of illegal drugs, with similar levels of access and waiting times. As alcohol consumption and alcohol related ill health have increased, the services needed to deal which these problems have not increased; indeed, in many cases they have decreased, partly as a result of the shift in resources to dependency on illegal drugs.
Early detection and intervention is both effective and cost effective, and could be easily be built into existing healthcare screening initiatives and incentives for doing this should be provided in the QOF. However the dire state of alcohol treatment services is a significant disincentive for primary care services to detect alcohol related issues at an early stage before the serious and expensive health consequences of regular heavy drinking have developed. These services must be improved.
The alcohol problem in this country reflects a failure of will and competence on the part of government Departments and quangos. In the past Governments have had a large influence on alcohol consumption, be it from the liberalisation which encouraged the eighteenth century 'Gin Craze' to the restrictions on licensing in the First World War. Alcohol is no ordinary commodity and its regulation is an ancient function of Government.
It is time the Government listened more to the CMO and the President of the RCP and less to the drinks and retail industry. If everyone drank responsibly the alcohol industry might lose about 40% of its sales and some estimates are higher. In formulating its alcohol strategy, the Government must be more sceptical about the industry's claims that it is in favour of responsible drinking.Read Full Contents
Thursday, January 7, 2010
Converging action of alcohol consumption and cannabinoid receptor activation on adult hippocampal neurogenesis
Alcoholism is characterized by successive periods of abstinence and relapse, resulting from long-lasting changes in various circuits of the central nervous system.
Accumulating evidence points to the endocannabinoid system as one of the most relevant biochemical systems mediating alcohol addiction. The endocannabinoid system regulates adult neurogenesis, a form of long-lasting adult plasticity that occurs in a few areas of the brain, including the dentate gyrus. Because exposure to psychotropic drugs regulates adult neurogenesis, it is possible that neurogenesis might be implicated in the pathophysiology, and hence treatment, of neurobiological illnesses related to drugs of abuse.
Here, we investigated the sensitivity of adult hippocampal neurogenesis to alcohol and the cannabinoid receptor agonist WIN 55,212-2 (WIN). Specifically, we analysed the potential link between alcohol relapse, cannabinoid receptor activation, and adult neurogenesis.
Adult rats were exposed to subchronic alcohol binge intoxication and received the cannabinoid receptor agonist WIN. Another group of rats were subjected to an alcohol operant self-administration task. Half of these latter animals had continuous access to alcohol, while the other half were subjected to alcohol deprivation, with or without WIN administration.
WIN treatment, when administered during alcohol deprivation, resulted in the greatest increase in alcohol consumption during relapse. Together, forced alcohol binge intoxication and WIN administration dramatically reduced hippocampal neurogenesis. Furthermore, adult neurogenesis inversely correlated with voluntary consumption of alcohol.
These findings suggest that adult hippocampal neurogenesis is a key factor involved in drug abuse and that it may provide a new strategy for the treatment of alcohol addiction and dependence.
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UK policy must address the links between alcohol and food in order to maximise the effectiveness of public health responses and enable people to make better informed choices about eating and drinking.
We urgently need to move away from seeing alcohol as a means to achieve inebriation to regarding itas an accompaniment to food with both being consumed in moderation.
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The following extract gives some insight into the context in which the Portman Group was established.
- "In 1989, a new public relations alliance was formed by the UK's leading alcohol companies. Instrumental in setting the ball rolling was (Lord) John Wakeham, a Tory peer and then chairman of the Ministerial Group on Alcohol Issues. According to Anthony Hurse, civil servant at the Department of Health: "Lord Wakeham made it clear to the alcohol industry that he would like the industry's collaboration. He spoke to Peter Mitchell Director of Strategic Affairs at Guinness who agreed he'd do what he could. As a consequence of Wakeham's suggestions, the UK's seven leading alcohol companies including Whitbread, Bass and Seagram, launched a new PR organisation from the headquarters of Guinness plc in London's Portman Square" .
The Portman Group's publicly stated aim is "to promote sensible drinking" However, according to Professor Nick Heather, former Director of the Newcastle Centre for Alcohol and Drug Studies, the Group's real agenda is rather different: "The attempt to distance alcohol as a drug from other kinds of drug and to give it a good face is the main activity of groups like the Portman Group." 
Nick distinguishes between harm reduction and harm elimination. He describes the way in which views of harm reduction in the USA have ‘muddied the waters’ in relation to the goal of controlled drinking. Nick says that the controlled drinking goal in the alcohol field may have been watered down more recently by the influence of the concept of harm reduction from the illicit drugs field.
Nick references George Ainslie’s work on ‘pico-economics’ and ‘breakdown of will’. He explains the idea of hyperbolic discounting and how this related to addiction. He also explores the concepts of resolutions and preferences and how these relate to our understanding of addiction.
Nick talks about the theory of how people resist temptation by findings ways of increasing the value later, larger rewards relative to earlier, smaller rewards, as described in the work of Jon Elster and George Ainslie..
Nick says we demonise illicit drugs use to irrational levels but equally we underestimate the harmful effects of alcohol.
He goes on the discuss ways of reducing alcohol-related harm by pricing. Controlling the alcohol industry and reducing health inequalities.
Wednesday, January 6, 2010
Nick describes the background of a conference he convened with Rudy Vuchinich on behavioural economics and its relevance to addiction, and the book that arose from this conference.
He also talks about Alcoholics Anonymous and how its benefits could be applied to secular mutual-aid groups.
He then references the work of Keith Humphreys on self-help groups.
Monday, January 4, 2010
|Alcohol consumption and its attendant problems are prevalent among adolescents and young adult college students. Harm reduction has been found efficacious with heavy drinking adolescents and college students.|
These harm reduction approaches do not demand abstinence and are designed to meet the individual where he or she is in the change process.
The authors present a case illustration of a harm reduction intervention, the Brief Alcohol Screening and Intervention for College Students (BASICS), with a heavy-drinking female college student experiencing significant problems as a result of her drinking.
BASICS is conducted in a motivational interviewing style and includes cognitive-behavioral skills training and personalized feedback.
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Adolescents alcohol-use and economic conditions: a multilevel analysis of data from a period with big economic changes
This paper examines how the unemployment rate is related to adolescent alcohol use and experience of binge drinking during a time period characterized by big societal changes.
The results show that the unemployment rate is negatively associated with adolescents’ alcohol use and the experience of binge drinking. When the unemployment rate increases, more adolescents do not drink at all. Regular drinking (twice per month or more) is, on the other hand, unrelated to the unemployment rate.
Examining gender-differences in the relationship, it is shown that the results are driven by behavior in girls, whereas drinking among boys does not show any significant relationship with changes in the unemployment rate.
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Challenging the “Inoffensiveness” of Regular Cannabis Use by Its Associations with Other Current Risky Substance Use—A Census of 20-Year-Old Swiss Men
3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users.
Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking.
Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky substance use.
A pressing public health issue among cannabis users stems from risky licit substance use warranting preventive efforts within this age group.
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Interventions and Assessments
- New Cocaine Vaccine Is Safe but Has Limited Efficacy
- Efficacy of Brief Intervention for Heavy Drinking in Hospitalized Patients Questionable
- Single-Question Alcohol Screen Detects Unhealthy Alcohol Use in a Primary Care Setting
- Methadone Treatment Documentation in the Medical Record: Implications for Patient Safety
- Brief Intervention for Hospitalized Patients with Problematic Prescription Drug Use: No Long-lasting Effects
- Prison-Initiated Methadone Maintenance Improves Postrelease Treatment Outcomes
- Abstinence Rates with Office-Based Buprenorphine Treatment Differ by Retention and Insurance Status
- Diverted Methadone and Buprenorphine Primarily Used to Prevent Withdrawal or to Stop Using Heroin
- Does Alcohol Use Affect Driving Performance in Patients with Obstructive Sleep Apnea?
- Methadone Contributes to Bone and Dental Disease: Fact or Fiction?
- Adults with Prescription-Opioid Dependence Engage in High Rates of HIV Risk Behaviors
- Inverse Association between Alcohol Consumption and Mortality May Differ by Ethnicity
- Does Folate Intake Modify the Association between Alcohol and Breast Cancer Risk?
- The Impact of Neighborhood Alcohol Outlet Density on Alcohol-related Health Outcomes
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