Aims

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.

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Saturday, December 4, 2010

Erosive Lesions in Patients With Alcoholism



The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance.

The authors conducted a cross-sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group). The authors determined the participants’ salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva.


The authors found more erosive lesions in the test group (P < .01). They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = .01). They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < .05).

The salivary flow rate was similar in control and test groups. The prevalence of erosion in the test group was higher than that in the control group, which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group. The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates.

Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels.



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Individuals Family History Positive for Alcoholism Show Functional Magnetic Resonance Imaging Differences in Reward Sensitivity That Are Related to Impulsivity Factors



Substance-abusing individuals tend to display abnormal reward processing and a vulnerability to being impulsive. Detoxified alcoholics show differences in regional brain activation during a monetary incentive delay task. However, there is limited information on whether this uncharacteristic behavior represents a biological predisposition toward alcohol abuse, a consequence of chronic alcohol use, or both.

We investigated proposed neural correlates of substance disorder risk by examining reward system activity during a monetary incentive delay task with separate reward prospect, reward anticipation, and reward outcome phases in 30 individuals with and 19 without family histories of alcoholism. All subjects were healthy, lacked DSM-IV past or current alcohol or substance abuse histories, and were free of illegal substances as verified by a urine toxicology screening at the time of scanning.
 

Additionally, we explored specific correlations between task-related nucleus accumbens (NAcc) activation and distinct factor analysis-derived domains of behavioral impulsivity.

During reward anticipation, functional magnetic resonance imaging data confirmed blunted NAcc activation in family history positive subjects. 

In addition, we found atypical activation in additional reward-associated brain regions during additional task phases. 

We further found a significant negative correlation between NAcc activation during reward anticipation and an impulsivity construct.

Overall, results demonstrate that sensitivity of the reward circuit, including NAcc, is functionally different in alcoholism family history positive individuals in multiple regards.



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Request Reprint -Mail:  godfrey.pearlson@yale.edu 

Response Inhibition Impairments Predict Alcohol-Induced Sedation



The aim of this study was to probe the relationship between the subjective effects of alcohol and impulsive behavior in social drinkers. 
 
Fifty social drinkers performed a response-inhibition task before consuming alcohol. A 0.8-g/kg dose of alcohol was administered in a binge-like fashion (0.2 g/kg every 30 min) to the participants over a 2-h time period. Participants then completed questionnaires measuring stimulation, sedation and mood following consumption of alcohol. Linear regression analyses were performed by examining the relationship between performance on the response inhibition impulsivity task and subjective responses to alcohol (i.e. stimulation, sedation and arousal). 

There was a significant positive relationship found between impulsive responding and self-reported sedation following alcohol consumption. Additionally, there was a significant negative relationship between behavioral impulsivity and self-reported stimulation and arousal following alcohol consumption.  

These results suggest that higher levels of impulsivity are associated with experiencing greater sedating than stimulating effects of alcohol. Individuals with high levels of impulsivity may be less sensitive to the stimulating effects of a specified dose of alcohol, which could lead to these individuals consuming more alcohol to experience the stimulating effects of alcohol. 



Request Reprint E-Mail:  aliguori@wfubmc.edu

News Release - Report on drink-driving does not go far enough, says BMA



Responding to the Transport Committee’s report (England) on drink-drive casualties launched today (Thursday 2 December 2010), the BMA’s Director of Professional Activities, Dr Vivienne Nathanson said:

“While the BMA is pleased that the Committee supports action to reduce drink-drive casualties, we are disappointed that it has not called for a reduction in the drink-drive limit. We disagree with the Committee that a reduction in the limit would send out mixed messages.
   > > > >    Read More

Drink and drug driving law - Transport Committee Contents



Drink driving
 
While we agree that medical and statistical evidence supports a reduction in the current drink drive limit of 80mg alcohol per 100ml blood, we note that currently 2% of drivers killed in road accidents have a blood alcohol concentration (BAC) between 50mg/100ml and 80mg/100ml, while 18% have a BAC greater than 80mg. We recommend that the police should have an additional power to enable preliminary breath tests to be required and administered in the course of a designated drink drive enforcement operation. 

We are concerned that a reduction in the limit to 50mg/100ml would send out a mixed message with the Government's official advice to not drink and drive at all, particularly in light of the strong evidence of public uncertainty about what constitutes a "legal drink". In the long term, we believe that the Government should aim for an "effectively zero" limit of 20mg/100ml but we acknowledge that is too great a step at this stage. Instead of an "interim" reduction to 50mg/100ml, the Government should concentrate on working with individual police forces to achieve a stricter enforcement of the current limit and beginning a public education campaign to help achieve public acceptance of a 20mg/100ml limit. 


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Depression associated with alcohol intake and younger age in Japanese office workers: A case-control and a cohort study



Depression influences a worker's productivity and health substantially. Recently, the Japanese society and government reported that working overtime is one of the primary causes of depression and suicide in workers. 

However, only a few studies have investigated the relation between overtime hours and mental health status, and conclusions vary. In addition, prior findings are inconsistent in terms of the relation between depression and lifestyle factors, including alcohol intake and smoking. Additional studies are required to clarify the relation between possible risk factors and depression in Japanese workers.
 
We performed a case-control and a cohort study. Subjects were office workers in four Japanese companies. Diagnosis of depression was made by two psychiatrists who conducted independent clinical interviews using DSM-IV-TR criteria.
 
There was no significant association between working overtime and the onset of depression. The frequency of alcohol intake was significantly related to the onset of depression. 

We also found a significant relation between younger age and depression onset. 

Body mass index and physical illness, including diabetes mellitus, had no significant association with depression onset.
 
Reducing working hours alone is unlikely to be effective in preventing workers' depression. Additional countermeasures are needed, including a reduction in alcohol intake and work stress.

Considerations for younger workers are also needed.




Request Reprint E-Mail:   ogakazu@work.nifty.jp 

Effects of in utero odorant exposure on neuroanatomical development of the olfactory bulb and odour preferences



Human babies and other young mammals prefer food odours and flavours of their mother's diet during pregnancy as well as their mother's individually distinctive odour. 

Newborn mice also prefer the individual odours of more closely related—even unfamiliar—lactating females. If exposure to in utero odorants—which include metabolites from the mother's diet and the foetus's genetically determined individual odour—helps shape the neuroanatomical development of the olfactory bulb, this could influence the perception of such biologically important odours that are preferred after birth. 

We exposed gene-targeted mice during gestation and nursing to odorants that activate GFP-tagged olfactory receptors (ORs) and then measured the effects on the size of tagged glomeruli in the olfactory bulb where axons from olfactory sensory neurons (OSNs) coalesce by OR type. 

We found significantly larger tagged glomeruli in mice exposed to these activating odorants in amniotic fluid, and later in mother's milk, as well as significant preferences for the activating odour. 

Larger glomeruli comprising OSNs that respond to consistently encountered odorants should enhance detection and discrimination of these subsequently preferred odours, which in nature would facilitate selection of palatable foods and kin recognition, through similarities in individual odours of relatives. 




Request Reprint E-Mail:   heth@research.haifa.ac.il
 

News Release - Confirmed: Baylor Study Pinpoints Molecular Mechanism that Causes Teens to be Less Sensitive to Alcohol than Adults



Researchers have known for years that teens are less sensitive than adults to the motor-impairing effects of alcohol, but they do not know exactly what is happening in the brain that causes teens to be less sensitive than adults. But now, neuropsychologists at Baylor University have found the particular cellular and molecular mechanisms underlying the age-dependent effect of alcohol in teens that may cause the reduced motor impairment.   > > > >  Read More

The ethnic density effect on alcohol use among ethnic minority people in the UK



Despite lower alcohol drinking rates of UK ethnic minority people (excluding Irish) compared with those of the white majority, events of racial discrimination expose ethnic minorities to unique stressors that elevate the risk for escapist drinking.

Studies of ethnic density, the geographical concentration of ethnic minorities in an area, have found racism to be less prevalent in areas of increased ethnic density, and this study hypothesises that ethnic minority people living in areas of high ethnic density will report less alcohol use relative to their counterparts, due to decreased experienced racism and increased sociocultural norms.

Multilevel logistic regressions were applied to data from the 1999 and 2004 Health Survey for England linked to ethnic density data from 2001 census.

Respondents living in non-White area types and areas of higher coethnic density reported decreased odds of being current drinkers relative to their counterparts. A statistically significant reduction in the odds of exceeding sensible drinking recommendations was observed for Caribbeans in Black area types, Africans in areas of higher coethnic density and Indian people living in Indian area types.

Results confirmed a protective ethnic density effect for current alcohol consumption, but showed a less consistent picture of an ethnic density effect for adherence to sensible drinking guidelines. 

Previous research has shown that alcohol use is increasing among ethnic minorities, and so a greater understanding of alcohol-related behaviour among UK ethnic minority people is important to establish their need for preventive care and advice on safe drinking practices. 




Request Reprint E-Mail:   becares@ucl.ac.uk
  

A randomized trial of extended telephone-based continuing care for alcohol dependence: Within-treatment substance use outcomes



The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOPs) improved outcomes for alcohol-dependent patients. 

Participants (N = 252) who completed 3 weeks of IOP were randomized to up to 36 sessions of TM (M = 11.5 sessions), TMC (M = 9.1 sessions), or IOP only (treatment as usual [TAU]). Quarterly assessment of alcohol use (79.9% assessed at 18 months) was corroborated with available collateral reports (N = 63 at 12 months). Participants with cocaine dependence (N = 199) also provided urine samples. 

Main effects favored TMC over TAU on any alcohol use (odds ratio [OR] = 1.88, CI [1.13, 3.14]) and any heavy alcohol use (OR = 1.74, CI [1.03, 2.94]). TMC produced fewer days of alcohol use during Months 10–18 and heavy alcohol use during Months 13–18 than TAU (ds = 0.46–0.65). TMC also produced fewer days of any alcohol use and heavy alcohol use than TM during Months 4–6 (ds = 0.39 and 0.43). TM produced lower percent days alcohol use than TAU during Months 10–12 and 13–15 (ds = 0.41 and 0.39). There were no treatment effects on rates of cocaine-positive urines. 

Adding telephone continuing care to IOP improved alcohol use outcomes relative to IOP alone. Conversely, shorter calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP.


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Longitudinal risk factors for intimate partner violence among men in treatment for alcohol use disorders.



This study examined static and time-varying risk factors for perpetration of intimate partner violence (IPV) among men in treatment for alcohol use disorders. 

Participants were 178 men diagnosed with alcohol abuse or dependence and their partners. Most (85%) of the men were European American; their average age was 41.0 years. Participants completed measures assessing initial alcohol problem severity, baseline beliefs related to alcohol use, antisocial personality characteristics, alcohol and drug use, relationship adjustment, and IPV. 

According to couples' reconciled reports, 42% of participants perpetrated IPV at baseline. Among this group, the IPV recurrence rate was 43% at 6-month follow-up and 36% at 12-month follow-up. For participants without IPV perpetration at baseline, new incidence of IPV was 15% and 7% at the 6-month and 12-month follow-up points, respectively. Fixed marker predictors of IPV rates included baseline alcohol problem severity variables, baseline beliefs related to alcohol use, and antisocial personality characteristics. Variable risk factor predictors included alcohol and drug use variables, relationship adjustment factors, and anger. Alcohol use variables and anger were associated with new incidents of IPV among those without reported IPV at baseline only. 

Findings suggest that assessing and monitoring IPV occurrence by both partners is important for men in treatment for alcohol use disorders. Results indicate vulnerability factors that may identify individuals at risk for IPV and provide targets for IPV prevention among those with alcohol use disorders. These findings can aid in the development of more comprehensive models that more precisely predict IPV. 



Request Reprint E-Mail:  
casey.taft@va.gov
 

Nudge or fudge? Public health fears as Lansley retreats from regulation

Doctors and academics are increasingly concerned that the Coalition is rolling back measures to combat high consumption of junk food, alcohol and cigarettes, and will fail to overhaul Britain's record as one of the fattest, unhealthiest countries in Europe.
The Health Secretary, Andrew Lansley, formerly a director of a marketing company with junk food clients, has declared his intention to press ahead with "nudges" to change behaviour rather than continue the "nannying" approach taken by Labour. > > > >   Read More

Accounting for the association between childhood maltreatment and alcohol-use disorders in males: a twin study



An association between childhood maltreatment and subsequent alcohol abuse and/or dependence (AAD) has been found in multiple studies of females. 

Less is known about the association between childhood maltreatment and AAD among males, and the mechanisms that underlie this association in either gender. 

One explanation is that childhood maltreatment increases risk for AAD. An alternative explanation is that the same genetic or environmental factors that increase a child's risk for being maltreated also contribute to risk for AAD in adulthood.

Lifetime diagnosis of AAD was assessed using structured clinical interviews in a sample of 3527 male participants aged 19–56 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. The sources of childhood maltreatment–AAD association were estimated using both a matched case–control analysis of twin pairs discordant for childhood maltreatment and bivariate twin modeling.

Approximately 9% of participants reported childhood maltreatment, defined as serious neglect, molestation, or physical abuse occurring before the age of 15 years. 

Those who experienced childhood maltreatment were 1.74 times as likely to meet AAD criteria compared with males who did not experience childhood maltreatment. 

The childhood maltreatment–AAD association largely reflected environmental factors in common to members of twin pairs.

Additional exploratory analyses provided evidence that AAD risk associated with childhood maltreatment was significantly attenuated after adjusting for measured family-level risk factors.

Males who experienced childhood maltreatment had an increased risk for AAD. Our results suggest that the childhood maltreatment–AAD association is attributable to broader environmental adversity shared between twins.



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Characterization of the Interactive Effects of Glycine and D-Cycloserine in Men: Further Evidence for Enhanced NMDA Receptor Function Associated with Human Alcohol Dependence



Reduced responses to N-methyl-D-aspartate (NMDA) glutamate receptor antagonists in alcohol-dependent animals and humans provided evidence that chronic alcohol consumption increased NMDA receptor function. 

To further probe alterations in NMDA glutamate receptor function associated with human alcohol dependence, this study examined the interactive effects of agents acting at the glycineB coagonist site of the NMDA receptor. 

In doing so, it tested the hypothesis that raising brain glycine concentrations would accentuate the antagonist-like effects of the glycineB partial agonist, D-cycloserine (DCS). 

Twenty-two alcohol-dependent men and 22 healthy individuals completed 4 test days, during which glycine 0.3g/kg or saline were administered intravenously and DCS 1000mg or placebo were administered orally. The study was conducted under double-blind conditions with randomized test day assignment. 

In this study, DCS produced alcohol-like effects in healthy subjects that were deemed similar to a single standard alcohol drink. 

The alcohol-like effects of DCS were blunted in alcohol-dependent patients, providing additional evidence of increased NMDA receptor function in this group. 

Although glycine administration reduced DCS plasma levels, glycine accentuated DCS effects previously associated with the NMDA receptor antagonists, ketamine and ethanol. 

Thus, this study provided evidence that raising glycine levels accentuated the NMDA receptor antagonist-like effects of DCS and that alcohol-dependent patients showed tolerance to these DCS effects.



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Friday, December 3, 2010

Estimating statistical power for open-enrollment group treatment trials



Modeling turnover in group membership has been identified as a key barrier contributing to a disconnect between the manner in which behavioral treatment is conducted (open-enrollment groups) and the designs of substance abuse treatment trials (closed-enrollment groups, individual therapy). 

Latent class pattern mixture models (LCPMMs) are emerging tools for modeling data from open-enrollment groups with membership turnover in recently proposed treatment trials. 

The current article illustrates an approach to conducting power analyses for open-enrollment designs based on the Monte Carlo simulation of LCPMM models using parameters derived from published data from a randomized controlled trial comparing Seeking Safety to a Community Care condition for women presenting with comorbid posttraumatic stress disorder and substance use disorders. 

The example addresses discrepancies between the analysis framework assumed in power analyses of many recently proposed open-enrollment trials and the proposed use of LCPMM for data analysis.


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Request Reprint E-Mail:   aaml@email.unc.edu  

Alcohol expectancy changes over a 12-week cognitive–behavioral therapy program are predictive of treatment success



This study examines if outcome expectancies (perceived consequences of engaging in certain behavior) and self-efficacy expectancies (confidence in personal capacity to regulate behavior) contribute to treatment outcome for alcohol dependence. 

Few clinical studies have examined these constructs. The Drinking Expectancy Profile (DEP), a psychometric measure of alcohol expectancy and drinking refusal self-efficacy, was administered to 298 alcohol-dependent patients (207 males) at assessment and on completion of a 12-week cognitive–behavioral therapy alcohol abstinence program. 

Baseline measures of expectancy and self-efficacy were not strong predictors of outcome. However, for the 164 patients who completed treatment, all alcohol expectancy and self-efficacy factors of the DEP showed change over time. 

The DEP scores approximated community norms at the end of treatment. 

Discriminant analysis indicated that change in social pressure drinking refusal self-efficacy, sexual enhancement expectancies, and assertion expectancies successfully discriminated those who successfully completed treatment from those who did not. 

Future research should examine the basis of expectancies related to social functioning as a possible mechanism of treatment response and a means to enhance treatment outcome.


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Request Reprint E-Mail:   gerald_feeney@health.qld.gov.au 

Advancing performance measures for use of medications in substance abuse treatment



Performance measures have the potential to drive high-quality health care. However, technical and policy challenges exist in developing and implementing measures to assess substance use disorder (SUD) pharmacotherapy. 

Of critical importance in advancing performance measures for use of SUD pharmacotherapy is the recognition that different measurement approaches may be needed in the public and private sectors and will be determined by the availability of different data collection and monitoring systems. 

In 2009, the Washington Circle convened a panel of nationally recognized insurers, purchasers, providers, policy makers, and researchers to address this topic. 

The charge of the panel was to identify opportunities and challenges in advancing use of SUD pharmacotherapy performance measures across a range of systems. 

This article summarizes those findings by identifying a number of critical themes related to advancing SUD pharmacotherapy performance measures, highlighting examples from the field, and recommending actions for policy makers.



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Request Reprint E-Mail:  cthomas@brandeis.edu 

Organizational factors associated with the use of contingency management in publicly funded substance abuse treatment centers



A promising area within technology transfer studies is the identification of organizational factors that influence the adoption of treatment innovations. 

Although studies have identified organizational factors associated with the adoption of pharmacological innovations, few studies have examined organizational factors in the adoption of psychosocial innovations, among which contingency management (CM) is a significant practice. 

Using data from a sample (N = 318) drawn from the population of publicly funded treatment centers in the United States, this study modeled organizational factors falling in the domains of structural characteristics, workforce variables, values and norms, and patient characteristics associated with the use of CM. 

Organizations were more likely to use CM if they embrace a supportive therapeutic approach, are research friendly, offer only outpatient levels of care, or serve drug-court patients. 

Implications for studying the diffusion and implementation of evidence-based psychosocial interventions are discussed.



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Request Reprint E-Mail:  bbride@uga.edu  

Alcohol and other drug treatment services in Australia 2008-09: report on the National Minimum Data Set


Around 143,000 alcohol and other drug treatment episodes were provided in Australia in 2008-09. 

More episodes of this treatment were for alcohol than any other drug type, and this proportion has now risen four years in a row. 

As with previous years, counselling was more prevalent than any other type of treatment. 

Alcohol and other drug treatment services in Australia 2008-09: report on the National Minimum Data Set presents data such as these on publicly funded alcohol and other drug treatment services and their clients. 


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The world health report - Health systems financing: the path to universal coverage



Good health is essential to human welfare and to sustained economic and social development. WHO's Member States have set themselves the target of developing their health financing systems to ensure that all people can use health services, while being protected against financial hardship associated with paying for them.
 
In this report, the World Health Organization maps out what countries can do to modify their financing systems so they can move more quickly towards this goal - universal coverage - and sustain the gains that have been achieved The report builds on new research and lessons learnt from country experience. It provides an action agenda for countries at all stages of development and proposes ways that the international community can better support efforts in low income countries to achieve universal coverage and improve health outcomes.

To raise funds to boost access to health care, the WHO "suggested governments should look at diversifying sources of revenue from levies such as 'sin' taxes on products like tobacco and alcohol, currency transaction taxes, and national 'solidarity' taxes on certain sectors”. 


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Thursday, December 2, 2010

Press Release - ZERO TOLERANCE FOR IRRESPONSIBLE ALCOHOL MARKETING


The Portman Group, the responsibility organisation for UK drinks producers, has launched a campaign to raise awareness of the strict standards imposed on the alcohol industry by its Code of Practice.

A series of full page ads in the media will highlight the rules and invite people to be on the look-out for any irresponsible alcohol products or marketing campaigns by drinks producers.

Complaints made under the Code are assessed by an independent panel.  Over 70 drinks have been taken off the shelves in the last decade after the panel ruled they were packaged or promoted irresponsibly.   > >  > >  Read More

Redesigning the Way that Public Health Policies and Priorities are Commuicated to Teenagers


The Boys and Girls Project, which is supported by the EU’s Health programme (2002-2013), will put together a series of websites that will explore the world of relationships, healthy lifestyles, body image and addiction. 

The group chose a web series believing they would have a greater impact on a young and technologically advanced teenage network. 

To reach such a broad audience the, “communication must be on their terms and in a language they understand and relate to.”
 

The web series will try to be relatable while at the same time enjoyable to sensitize Europe’s youth about some of the most pressing public health concerns today. 

The aim target group is teenagers between the ages of 15 and 18, although the project hopes to attract viewers of any age. 

The goal is to change the tide of recently developed unhealthy health habits in European teenagers, such as binge drinking, and hopefully influence the younger generation to lead happier, healthier lifestyles.    > > > >    Read More

The Role of Nonlinear Relapse on Contagion Amongst Drinking Communities

 


Relapse, the recurrence of a disorder following a symptomatic remission, is a frequent outcome in substance abuse disorders. Some of our prior results suggested that relapse, in the context of abusive drinking, is likely an “unbeatable" force as long as recovered individuals continue to interact in the environments that lead to and/or reinforce the persistence of abusive drinking behaviors.

Our earlier results were obtained via a deterministic model that ignored differences between individuals, that is, in a rather simple “social" setting.
 

In this paper, we address the role of relapse on drinking dynamics but use models that incorporate the role of “chance", or a high degree of “social" heterogeneity, or both. Our focus is primarily on situations where relapse rates are high.

We first use a Markov chain model to simulate the effect of relapse on drinking dynamics. These simulations reinforce the conclusions obtained before, with the usual caveats that arise when the outcomes of deterministic and stochastic models are compared. 

However, the simulation results generated from stochastic realizations of an “equivalent" drinking process in populations “living" in small world networks, parameterized via a disorder parameter p, show that there is no social structure within this family capable of reducing the impact of high relapse rates on drinking prevalence, even if we drastically limit the interactions between individuals (p _ 0). 

Social structure does not matter when it comes to reducing abusive drinking if treatment and education efforts are ineffective.

These results support earlier mathematical work on the dynamics of eating disorders and on the spread of the use of illicit drugs. 

We conclude that the systematic removal of individuals from high risk environments, or the development of programs that limit access or reduce the residence times in such environments (or both approaches combined) may reduce the levels of alcohol abuse.


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Sensitivity Analysis of Drinking Dynamics: From Deterministic to Stochastic Formulations



The similarities between drinking behavior and contagion are used to explore — under two types of social structure in the population: homogenous and heterogeneous mixing— the role of nonlinear social interactions on the dynamics of alcohol consumption; quantifying how some model parameters influence the latter dynamics. 

A deterministic model, assuming homogeneous mixing, is used to derive relative sensitivity functions which explain how the recovery and relapse rates affect the establishment of problem drinkers. 

A continuos-time Markov chain model is derived from the deterministic model; stochastic simulations are used to quantify how histograms of the number of problem drinkers depend on the recovery and relapse rates, as these rates are gradually incremented. 

The impact of lowering the relapse rate, as a result of successful treatment, at various intervention times, is assessed by stochastic simulations of drinking dynamics among communities with small-world structure; reductions in the average number of problem drinkers are obtained —with some community structures showing more vulnerability to higher levels of prevalence than others. 

We concludefrom sensitivity analyses (of deterministic and stochastic models) that, either: increasing the recovery rate; or lowering the relapse rate, are measures with positive effects
—they tend to reduce the number of problem drinkers.




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Fruit and vegetables and cancer risk



The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. 

For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. 

For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. 

For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. 

It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. 

Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. 

Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.




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Alcohol and homicide in Australia


International research suggests alcohol consumption increases the number of homicides and that homicides involving alcohol differ significantly to non alcohol-related homicides. 

The current study sought to build on the limited Australian research on alcohol-related homicide by examining solved homicides recorded in the National Homicide Monitoring Program over a six year period. 

Of the 1,565 homicides, nearly half (47%) of the incidents were classified as alcohol related and of those, over half involved both the victim and offender consuming alcohol prior to the incident. 

Similar to previous research, the analysis found victim, offender and incident characteristics differentiated alcohol-related homicides from other homicides. 

Further analysis showed that the incident characteristics most clearly differentiate alcohol-related homicides, which highlights the crucial role situational and environmental factors play in precipitating alcohol-related homicide. 

A key finding, not found in earlier research, was that alcohol is equally likely to be implicated in intimate-partner homicides as it is in all other homicides. 

However, homicides involving women killing male intimate partners were far more likely to involve alcohol consumption by victim or offender or both, and that the overwhelming majority of Indigenous intimate-partner homicides were alcohol related.


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A longitudinal analysis of alcohol outlet density and domestic violence



A small number of studies have identified a positive relationship between alcohol outlet density and domestic violence. These studies have all been based on cross-sectional data and have been limited to assess ecological correlations between outlet density and domestic violence rates. 

This study provides the first longitudinal examination of this relationship.

The study uses data for 186 postcodes from within the metropolitan area of Melbourne, Australia for the years 1996 to 2005. Alcohol outlet density measures for three different types of outlets (hotel/pub, packaged liquor, on-premise) were derived from liquor licensing records and domestic violence rates were calculated from police recorded crime data, based on postcode of the victim. The relationships between these three types of alcohol outlet density and domestic violence were assessed over time using a fixed-effects model. Controls for the spatial autocorrelation of the data were included in the model.
Alcohol outlet density was significantly associated with rates of domestic violence, over time. In particular, the density of hotel (pub) licences and the density of packaged liquor licences were positively related to domestic violence rates and the density of on-premise licences was negatively related to domestic violence.
In Melbourne, changes in density of hotel (pub) licenses and packaged liquor licenses have been positively associated with changes in rates of domestic violence whereas the rates of on-site liquor licenses have been negatively associated with domestic violence.


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Request Reprint E-Mail:   
michaell@turningpoint.org.au
  

Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men




To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption.

Of 3669 consecutive adult male inpatients, 616 were identified as unhealthy alcohol users (> 14 drinks/week) and randomly assigned to either usual care (n= 308) or a brief intervention (n= 308).


Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self-reported weekly alcohol consumption, drinking days, and heavy drinking episodes assessed by 7-day timeline follow-back. Secondary outcomes were 1) self-reported alcohol problems, 2) health care utilization (hospital days and emergency department visits), 3) self-reported seeking of specialty treatment for alcohol problems, and 4) 3-month Quick Drinking Screen.


Based on intention-to-treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol-dependent participants over 12 months, on both 7-day and 3-month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19/230 vs. 2.1%, 4/189) consulted specialists by 12 months (P= 0.01). However, alcohol-related problems and health care utilization did not differ significantly in the two groups during follow-up.


Data from Taiwan confirm that brief in-hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.


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Request Reprint E-Mail:  maryliuyip@gmail.com 

Drugs and addiction: An introduction to epigenetics


Addiction is a debilitating psychiatric disorder with a complex aetiology involving the interaction of inherited predispositions and environmental factors. Emerging evidence suggests that epigenetic alterations to the genome, including DNA methylation and histone modifications, are important mechanisms underlying addiction and the neurobiological response to addictive substances. 

In this review, we introduce the reader to epigenetic mechanisms and describe a potential role for dynamic epigenetic changes in mediating addictive behaviours via long-lasting changes in gene expression. 

We summarise recent findings from both molecular and behavioural experiments elucidating the role of epigenetic changes in mediating the addictive potential of various drugs of abuse including cocaine, amphetamine and alcohol. 

The implications of these findings for molecular studies of addiction and the future development of novel therapeutic interventions are also discussed.




Request Reprint E-Mail:  jonathan.mill@kcl.ac.uk   

-Comparison of Two Oral Symptom-triggered Pharmacological Inpatient Treatments of Acute Alcohol Withdrawal: Clomethiazole vs. Clonazepam



To compare two inpatient symptom-triggered pharmacological treatments of acute alcohol withdrawal (AWS) (clomethiazole vs. clonazepam).
 
Prospective observational comparison within a quality improvement project. Because of a need for extra precautions against complications such as seizures and severe respiratory complaints, patients with a history of withdrawal seizures or complications with clomethiazole in their history were automatically assigned to the clonazepam group. The remaining patients were alternately assigned either to the clonazepam group (= 38 altogether) or the clomethiazole group (= 36). Rescue medication could consist of adding either extra clonazepam or clomethiazole. Effectiveness was measured by Clinical Global Impression Scale, Revised Clinical Institute Withdrawal Assessment for Alcohol Scale, Mainz Alcohol Withdrawal Scale, Essen Self-Assessment-Alcohol Withdrawal and attrition rate. Safety and tolerability was estimated from adverse clinical events. Secondary outcome values were heart rate, blood and pulse pressure.
 
There were no significant differences between the treatments with respect to primary and secondary effectiveness measures, safety or tolerability or duration of medication treatment. Both reduced the severity of initial withdrawal symptoms below 20% up to the ending of withdrawal medications. No withdrawal seizure or delirium occurred.
 
Both score-driven treatments were equally effective, safe and well tolerated in this setting. 

This is the first study demonstrating the utility of clonazepam in the treatment of AWS syndrome. 



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Ethanol Reduces Zincosome Formation in Cultured Astrocytes



Zinc is an ion that participates in basic cellular and tissular functions. Zinc deficiency is present in many physiological and health problems affecting most body organs, including the brain. Among the circumstances involved in zinc deficiency, ethanol consumption is probably one of the most frequent. A dietary zinc supplement has been proposed as possibly being an efficient method to palliate zinc deficiency. Astrocytes form part of the hematoencephalic barrier, and they are apparently implicated in the homeostasis of the neuronal medium. 

In this work, we analyze the effect of ethanol on extracellular zinc management by rat astrocytes in culture. 

Intracellular levels of ‘free zinc ions’, in controls and 30 mM ethanol-treated astrocytes, were visualized by using the zinc fluorochrome TSQ. Cytoplasmic fluorescence and zincosome formation were measured after adding extracellular 50 ┬ÁM ZnSO4 to cell monolayers. Zincosomes were also observed at the electron microscopy level.

 Exposure to ethanol for 7 days lowered the basal zinc levels of astrocytes by ∼30%. This difference was consistently maintained after the zinc pulse. Zinc ions were confined to bright fluorescent particles, the ‘zincosomes’, which appeared to be formed by the endocytic pathway. Zincosomes were less abundant in alcohol-treated cells, indicating a deficit in endocytoses as the origin of low zinc intake in astrocytes after ethanol treatment. 

Ethanol reduces both intracellular ionic zinc levels and extracellular zinc uptake, resulting in poorer zincosome formation. Given the endocytic nature of zincosomes, the effect of ethanol on membrane trafficking is apparently the origin of this deficit.



 
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Alveolar Macrophage Gene Expression Is Altered in the Setting of Alcohol Use Disorders



Alcohol use disorders (AUDs) are associated with an increased susceptibility to a variety of common and devastating pulmonary diseases including community- and hospital-acquired pneumonias, as well as the acute respiratory distress syndrome (ARDS). Alveolar macrophages play an important role in preventing the development of these disorders through maintaining lung sterility and resolving lung inflammation. Although alcohol exposure has been associated with aberrant alveolar macrophage function in animal models, the clinical relevance of these observations in humans is not established. Therefore, we sought to determine the effects of AUDs on human alveolar macrophage gene expression.
Whole genome microarray analysis was performed on alveolar macrophages obtained by bronchoalveolar lavage from a test cohort of subjects with AUDs (n = 7), and controls (n = 7) who were pair-matched on age, gender, and smoking. Probe set expression differences in this cohort were validated by real-time reverse transcription-polymerase chain reaction (RT RT-PCR). Functional analysis with web-based bioinformatics tools was utilized with microarray data to assess differentially expressed candidate genes (p < 0.01) based on alcohol consumption. Alveolar macrophage mRNA samples from a second cohort of subjects with AUDs (n = 7) and controls (n = 7) were used to confirm gene expression differences related to AUDs.
In both the test and the confirmatory cohorts, AUDs were associated with upregulation of alveolar macrophage gene expression related to apoptosis, including perforin-1, granzyme A, and CXCR4 (fusin). Pathways governing the regulation of progression through cell cycle and immune response were also affected, as was upregulation of gene expression for mitochondrial superoxide dismutase. 

Overall, 12 genes’ expression was affected by AUDs independent of smoking.
Alcohol use disorders are associated with unique changes in human alveolar macrophage gene expression. Novel therapies targeting alveolar macrophage gene expression in the setting of AUDs may prove to be clinically useful in limiting susceptibility for pulmonary disorders in these individuals.




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