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, March 5, 2011

Risk factors for fatal crashes in rural Australia

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. 

During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. 

Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. 

Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. 

After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. 

Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing.

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Let them experience a ride under the influence of alcohol; A successful intervention program?

A considerable amount of all traffic accidents can be attributed to driving under the influence of alcohol. 

In particular the group of drivers aged 18–24 years is involved in many serious traffic accidents where alcohol turns out to be a major factor. In fact this age group shows about three times as many alcohol related traffic fatalities as all other categories of road users. 

The intervention program “Alcohol-free on the road” (Dutch: “Alcoholvrij op weg”) aims to enhance young people's awareness of the effects of alcohol by letting them personally experience the effect of alcohol on their driving abilities. 

To this end, young drivers were invited to a closed circuit and allowed to drive first sober and then intoxicated, guided and guarded by driving instructors. 

Based on several other studies it was thought that a realistic experience of the effects of alcohol on driving abilities may contribute to a better understanding of the impact of alcohol and may stimulate attitudes that are needed to support the conscious decision not to drive while intoxicated.

After more than ten years of running and data collection, 1200 young drivers have participated in the intervention program. In a quasi-experimental study with a non-equivalent group design, the program is evaluated in order to assess its effectiveness both with respect to the attitudes of the participants and the actual relevant behaviour in the years after the alcohol experience intervention program they attended, i.e. the incidence of actually driving under the influence of alcohol. 

To do this, a questionnaire was sent to a subset (415) of the participants who have completed the program, along with a control group (450), to compare attitudes and actual behaviour. In addition, the Public Prosecutor checked the files of those who responded, for the occurrence of driving under the influence of alcohol. 

The group that participated in the alcohol intervention program showed more awareness about the dangers of driving while intoxicated than the control group, and this group reported improved alcohol law compliance. 

Furthermore, less participants in the intervention program than in the control group were present in the Public Prosecutor files, respectively 0.7% and 4.2%. Hence, the alcohol driving experience intervention program might turn out to be effective and successful in decreasing driving under the influence of alcohol. 

Although the results of the present study are no more than suggestive, they may be considered a first step towards demonstrating the effectiveness of this type of intervention. 

However, the intervention is unique and warrants a more robust evaluation. A large-sized randomized controlled trial should be conducted in the next phase to confirm the findings that the intervention program is a suitable educational tool to decrease driving under the influence of alcohol. 

The present paper serves to raise awareness of this intervention and its potential.

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Validation of sobriety tests for the marine environment

The objective of this project was to develop sobriety tests that can be administered in the seated position to assist water patrol officers in detecting alcohol-related impairment in boaters. 

Four seated sobriety tests were administered to 330 boaters to determine the tests’ usefulness in classifying boaters as having blood alcohol concentrations (BACs) below the illegal limit (BAC < .08%) or above the illegal limit (BAC ≥ .08%). 

Data were obtained by a team of four marine officers and two civilian observers on Lake of the Ozarks in central Missouri. 

The overall correct percentages, sensitivity, and specificity of the tests were consistent with what is typically reported in literature on the roadside sobriety tests. The tests’ reliability was also consistent with what is typically reported in literature on the roadside sobriety tests. 

Thus, the four tests may assist marine officers with assessments of alcohol-related impairment in boaters.

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Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo

The aims of the present study were to characterize fatal traffic accident victims in a major urban center in Brazil and their association with alcohol consumption.

Cross-sectional study of 907 fatal traffic accident victims in Sao Paulo, in 2005.

Adult males between the ages of 25 and 54 represented the majority of cases with positive blood alcohol concentrations (BAC). Overall, males had a higher proportion of BAC and mean BAC than females. Pedestrians, particularly those with no detectable BAC, were typically older than other victims. Most accidents (total and BAC-positive) happened on weekends between midnight and 6 a.m. Considering all victims, 39.4% were positive (BAC over 0.1 g/l). When only drivers (automobile, motorcycle and bicycle) were evaluated, 42.3% had BAC over the legal limit (0.6 g/l).

Alcohol is associated with nearly half of all traffic accident deaths in the city of Sao Paulo, especially for days and times associated with parties and bars (weekends between 12 a.m. and 6 a.m.).

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Alcohol pouring practices among 65- to 74-year-olds in Western Australia

Alcohol pouring practices have relevance to the validity of self-reported alcohol consumption. However, little research has focused on older populations nor investigated relationships between volumes poured and participants' estimations of beverages in terms of Australian standard drinks. The aim of this study was to address these issues.
Interviews were conducted (in participants' homes) with 844 current drinkers, aged 65–74 years, from Perth, Western Australia. Participants poured their ‘usual’ serving of alcohol into their ‘usual’ drinking vessel and were asked questions regarding the volumes poured.
Older men poured drinks that were 32% larger than a standard drink (10 g of ethanol). The comparable figure for older women was 16%. However, over 25% of all men and 20% of all women indicated they would not record (in a self-report assessment of consumption) the amount poured as one standard drink. Despite participants making corrections, men and women still underestimated amounts poured (men by 23% and women by 16%).
As with younger populations, older people pour drinks that are, on average, larger than standard drinks. To increase the accuracy of self-reported consumption, it is recommended that researchers consider pouring practices and people's perceptions of alcohol volumes poured in relation to a standard drink. 

Further research on this issue may reduce the discrepancy between self-reported levels of consumption and national per capita alcohol sales.

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Friday, March 4, 2011

Characteristics of Probation and Parole Admissions Aged 18 or Older

The most common substances of abuse reported by probation or parole admissions were alcohol (30.6 percent), marijuana (26.4 percent), and methamphetamines (15.6 percent); more than one half reported more than one substance of abuse at admission (59.2 percent). 

The majority of probation or parole admissions were male (76.6 percent), had never married (63.1 percent), were between the ages of 18 and 44 (81.3 percent), and were non-Hispanic White (52.3 percent). 

Over one third of the probation and parole admissions had less than a high school education (39.6); the majority of these admissions were unemployed (36.8 percent) or not in the labor force (26.2 percent). 

The majority had been in treatment at least once before (57.5 percent); 18.4 percent reported three or more prior treatment episodes. 

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Parents can help their children develop healthy attitudes toward drinking while minimizing its risk

Drinking alcohol undoubtedly is a part of American culture, as are conversations between parents and children about its risks and potential benefits. However, information about alcohol can seem contradictory. Alcohol affects people differently at different stages of life—small amounts may have health benefits for certain adults, but for children and adolescents, alcohol can interfere with normal brain development. Alcohol’s differing effects and parents’ changing role in their children’s lives as they mature and seek greater independence can make talking about alcohol a challenge. Parents may have trouble setting concrete family policies for alcohol use. And they may find it difficult to communicate with children and adolescents about alcohol-related issues.
Research shows, however, that teens and young adults do believe their parents should have a say in whether they drink alcohol. Parenting styles are important—teens raised with a combination of encouragement, warmth, and appropriate discipline are more likely to respect their parents’ boundaries. Understanding parental influence on children through conscious and unconscious efforts, as well as when and how to talk with children about alcohol, can help parents have more influence than they might think on a child’s alcohol use. Parents can play an important role in helping their children develop healthy attitudes toward drinking while minimizing its risk.  > > > >   Read More

The effects of a large reduction in alcohol prices on hospitalizations related to alcohol: a population-based natural experiment

Finland experienced a large reduction in alcohol prices in 2004 due to in the lowering of alcohol taxes by about one-third and the abolition of duty-free allowances for travellers from the European Union. We examined the effects of these changes on alcohol-related hospitalizations.

Time—series intervention analyses of monthly aggregations of hospitalization for acute and chronic causes among men and women aged 15–39, 40–49, 50–69 and more than 69 years.

 After the price reduction the chronic hospitalization rate for men increased among those below age 70 years. It was largest among those aged 50–69 years: 22%, which implies an increase of 18.0 monthly hospitalizations per 100 000 person-years, and there was an 11% and 16% (11.5 and 4.8 monthly hospitalizations) increase among those aged 40–49 and 15–39, respectively. Among the women the rate increased by 23% (4.0 monthly hospitalizations) in the 50–69-year-olds, and decreased in the under-40s. The increase in all the population groups was due mainly to an increase in mental and behavioural disorders due to alcohol. Acute hospitalizations increased by 17% and 20% (6.2 and 7.0 per month) among men aged 40–49 and 50–69 years, respectively, and by 38% among women aged 50–69 years (2.3 per month).
The results, obtained in a natural experimental setting when trends and seasonal variation had been taken into account, suggest that the reduction in alcohol prices led to increases in alcohol-related hospitalization in certain population groups, mainly among 50–69-year-olds, in Finland.

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Factors Related to Medicaid Payment Acceptance at Outpatient Substance Abuse Treatment Programs

To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs.

Secondary analysis of 2003–2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly available data.

We used cross-sectional analyses, including state fixed effects, to assess relationships between SA treatment program Medicaid acceptance and (1) program-level factors, (2) county-level sociodemographics and treatment program density, and (3) state-level population characteristics, SA treatment-related factors, and Medicaid policy and usage.
State Medicaid policy data were compiled based on reviews of state Medicaid-related statutes/regulations and Medicaid plans. Other data were publicly available.

Medicaid acceptance was significantly higher for programs: (a) that were publicly funded and in states with Medicaid policy allowing SA treatment coverage; (b) with accreditation/licensure and nonprofit/government ownership, as well as mental- and general-health focused programs; and (c) in counties with lower household income.

SA treatment program Medicaid acceptance related to program-, county, and state-level factors. The data suggest the importance of state policy and licensure/accreditation requirements in increasing SA program Medicaid access.

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The Seven Key Messages of the Alcohol Industry

The alcohol and tobacco industry sell products that can be dangerous to our health. For this reason, governments take action by, for example, raising taxes, enforcing age limits, prescribing warning labels and restricting advertising and sponsoring.

Literature shows that the “industry”—the alcohol and tobacco companies—have traditionally
worked closely together, sharing information and concerns about regulation. They have used similar arguments to defend their products in order to prevent or delay restrictions being placed on them (Bond, et al. 2010).

The intention of this brochure is to inform professionals about the attempts made by the alcohol industry to influence alcohol policy
globally and to subsequently arm them against the industry’s methods to prevent effective policies from being made.

If you have comments regarding this brochure or examples of the alcohol industry’s lobbying practices please send them by email to the
European Centre for Monitoring Alcohol Marketing (EUCAM).

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Smoking and alcohol consumption in relation to risk of triple-negative breast cancer in a cohort of postmenopausal women

Little is known about the risk factors for triple-negative breast cancer (TNBC), which has a worse prognosis compared to hormone receptor-positive breast cancer.

We examined the association of smoking and alcohol intake with TNBC and estrogen receptor-positive (ER+) breast cancer.  

Among 148,030 women enrolled in the Women’s Health Initiative, 300 TNBC cases and 2,479 ER+ cases were identified over a median of 8.0 years of follow-up. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI).

Cigarette smoking was not associated with TNBC, whereas drinkers had reduced risk compared to never drinkers. In contrast, both exposures showed slight positive associations with ER+ breast cancer: for women with ≥40 pack-years of smoking, the HR was 1.24, 95% CI 1.06–1.44; for women consuming ≥7 servings of alcohol per week, the HR was 1.26, 95% CI 1.06–1.50. Intakes of wine and hard liquor were also significantly positively associated with ER+ breast cancer.

These findings from a large cohort of postmenopausal women suggest that smoking and alcohol consumption are not associated with increased risk of TNBC, but may be modestly associated with increased risk of ER+ breast cancer.

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Conference - Innovation on the ATOD Frontier: Now's the Time

33rd Annual SALIS Conference

May 3-6, 2011

Kansas City, Missouri

Registration is OPEN for the 33rd Annual SALIS Conference in Kansas City, hosted by Laurie Krom, Director of the Addiction Technology Transfer Centers (ATTC) National Office, featuring presentations by SALIS members and invited speakers. The conference hotel will be the Hilton President-Kansas City.  > > > >   Read More

Disruption of Functional Connectivity of the Default-Mode Network in Alcoholism

The default mode network (DMN) comprises brain structures maximally active at rest. Disturbance of network nodes or their connections occurs with some neuropsychiatric conditions and may underlie associated dysfunction. DMN connectivity has not been examined in alcoholism, which is marked by compromised DMN nodes and impaired spatial working memory.

To test whether performance would be related to DMN integrity, we examined DMN functional connectivity using functional magnetic resonance imaging (fMRI) data and graph theory analysis. We assumed that disruption of short paths between network nodes would attenuate processing efficiency. Alcoholics and controls were scanned at rest and during a spatial working memory task.

At rest, the spontaneous slow fluctuations of fMRI signals in the posterior cingulate and cerebellar regions in alcoholics were less synchronized than in controls, indicative of compromised functional connectivity.

Graph theory analysis indicated that during rest, alcoholics had significantly lower efficiency indices than controls between the posterior cingulate seed and multiple cerebellar sites.

Greater efficiency in several connections correlated with longer sobriety in alcoholics.

During the task, on which alcoholics performed on par with controls, connectivity between the left posterior cingulate seed and left cerebellar regions was more robust in alcoholics than controls and suggests compensatory networking to achieve normal performance.

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Conference - Tobacco and Alcohol: Learning from each other, 12-13 October 2011, Cardiff (UK

Cigarette smoking is highly prevalent among people with alcohol use disorders. People who are dependent on alcohol are three times more likely than those in the general population to be smokers, and people who are dependent on tobacco are four times more likely than the general population to be dependent on alcohol. Alcohol use problems are associated with higher levels of nicotine dependence and a lower likelihood of smoking cessation. More alcoholics die of tobacco-related illness than die of alcohol-related problems.

The link between alcohol and tobacco has important implications for those in the alcohol and smoking cessation treatment and policy fields. The conference will enable alcohol and tobacco treatment providers and policy makers the opportunity to learn from each other. In addition to co-use issues, the conference will offer alcohol and tobacco specific sessions for practitioners.

Download the preliminary conference programme   (PDF)

Thursday, March 3, 2011

Predictors and consequences of simultaneous alcohol and cannabis use in adolescents

The simultaneous use of alcohol and cannabis is common among adolescents, but has been little studied. In this study, we examine predictors and consequences of this behavior in a population-based sample of high school students.

Self-reports were obtained from students in Quebec (Canada) followed throughout high school (N = 6 589). Logistic regressions were used to test the association between individual, family, and peer-related predictors in grades 7–8 and simultaneous alcohol and cannabis use in grade 10, as well as between simultaneous alcohol and cannabis use in grade 10 and substance-related problems of various types (legal, physical, etc. in grade 11.

Most predictors in grades 7–8 were associated with simultaneous alcohol and cannabis use in grade 10. Only variables reflecting early-onset substance use involvement - binge drinking, cannabis use, and drug use by close friend(s) – remained predictive in a multivariate model.

Simultaneous alcohol and cannabis use was associated with increased substance-related problems in grade 11, above and beyond baseline problems in grade 10 and the concurrent use of the two substances in separate episodes.

Simultaneous alcohol and cannabis use 1) is anticipated by multiple psychosocial risk factors which come together with individual and peer substance use in early high school and 2) is independently predictive of subsequent substance-related problems. Providing adolescents with adequate information regarding the potential harm of simultaneous use is imperative.

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Using ZIP code business patterns data to measure alcohol outlet density

Some states maintain high-quality alcohol outlet databases but quality varies by state, making comprehensive comparative analysis across US communities difficult.

This study assesses the adequacy of using ZIP Code Business Patterns (ZIP-BP) data on establishments as estimates of the number of alcohol outlets by ZIP code. Specifically we compare ZIP-BP alcohol outlet counts with high-quality data from state and local records surrounding 44 college campus communities across 10 states plus the District of Columbia.

Results show that a composite measure is strongly correlated (R = 0.89) with counts of alcohol outlets generated from official state records. Analyses based on Generalized Estimation Equation models show that community and contextual factors have little impact on the concordance between the two data sources. There are also minimal inter-state differences in the level of agreement.

To validate the use of a convenient secondary data set (ZIP-BP) it is important to have a high correlation with the more complex, high quality and more costly data product (i.e., datasets based on the acquisition and geocoding of state and local records) and then to clearly demonstrate that the discrepancy between the two to be unrelated to relevant explanatory variables.

Thus our overall findings support the adequacy of using a conveniently available data set (ZIP-BP data) to estimate alcohol outlet densities in ZIP code areas in future research.

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Vulnerability to peer influence: A moderated mediation study of early adolescent alcohol use initiation

Affiliation with deviant peers is a correlate of adolescent alcohol use; however, the mechanism accounting for this association remains unclear, particularly with respect to initiation of alcohol use in early adolescence.

This prospective study examines perceived peer attitudes and use as a mediator between peer delinquency and initiation of alcohol use, and how parenting may moderate vulnerability to this risk pathway.

Participants included 371 11–13 year-old adolescents (55.5% female, 83.0% Caucasian).

Results suggested that high levels of peer delinquency prospectively predicted perceived peer approval and use of alcohol and that peer approval and use of alcohol prospectively predicted initiation of alcohol use.

Thus, reinforcement and modeling alcohol use appear to be important mechanisms by which delinquent peers influence the initiation of drinking. There was no support for parental warmth or control as moderators of peer influence.

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Drinking in context: the influence of gender and neighbourhood deprivation on alcohol consumption

Findings from contextual studies have shown that living in both poor and affluent neighbourhoods increases the risk of drinking and drug use, but few studies have examined the connection between neighbourhood context and drinking from a gender perspective.

We investigated the association between gender, neighbourhood deprivation and weekly drinking behaviour (number of drinks) in a national sample of 93 457 Canadians using multilevel zero-inflated Poisson regression. A cross-level interaction between gender and neighbourhood deprivation was examined while controlling for other potential risk factors.

53% of Canadians reported having at least one drink in the last year (men=61%; women=46%). Among respondents who were drinkers, the average number of drinks per week was 6.4 with male drinkers reporting an average of 7.9 and female drinkers reporting an average of 4.6. Neighbourhood material deprivation was independently associated with weekly drinking. Findings from multilevel analysis showed a u-shaped curve between neighbourhood deprivation and drinking, but only for men. Men living in the poorest neighbourhoods drank more weekly (8.5 drinks) than men living in neighbourhoods of wealthy (4.5 drinks) and mid-range deprivation (3.7 drinks). No difference in drinking by neighbourhood material deprivation was observed among women.

Men, like women, experience gender-specific health difficulties (eg, alcohol-related problems) suggesting the need for a gendered focus on policies and services related to women's and men's health. The challenge for public health and primary care is to work together to target risk-taking behaviours among men through treatment, prevention and cultural/educational messages aimed at building healthy lifestyles.

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A systematic and methodological review of interventions for young people experiencing alcohol-related harm

This review: (1) identified published studies evaluating interventions delivered outside educational settings, designed for young people with existing alcohol use problems, or who participate in behaviour that places them at high-risk of alcohol-related harm; (2) critiqued their methodology; and (3) identified opportunities for new interventions.

A systematic search of the peer-reviewed literature interrogated ten electronic databases using specific search strings, limited to 2005-2009. No additional studies were found by a librarian searching other collections and clearinghouses, or by hand-searching review paper reference lists. The 1697 articles identified were reviewed against criteria from the Dictionary for the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.

The methodological quality of existing studies is variable and needs to be both more rigorous and more consistent. Particular problems include the lack of blinding outcome assessors, a reliance solely on self-report measures, highly variable consent and follow-up rates, infrequent use of intention-to-treat analyses and the absence of any economic or cost analyses. The range of interventions evaluated is currently limited to individually-focused approaches, almost exclusively implemented in the United States.

There is a great need for more intervention trials for young people at high-risk of experiencing alcohol related harm that are both methodologically rigorous and have a broader community focus, to complement the psychological interventions that currently dominate the relevant literature. Such trials would improve outcomes for high-risk young people themselves and would improve the evidence base, both in their own right and by facilitating future meta-analyses.

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Metacognition, emotion, and alcohol dependence in college students: A moderated mediation model

Based on Wells and Matthews’ (1994) theory of psychological dysfunction and prior empirical studies, it was hypothesized that negative emotion would mediate the relationship between maladaptive metacognition and alcohol dependence, and maladaptive metacognition would moderate the relationship between negative emotion and alcohol dependence.

A sample of 300 British college students completed the Alcohol Use Disorders Identification Test, Hospital Anxiety and Depression Scale, and Meta-Cognitions Questionnaire 30. Metacognitive traits, emotions, and alcohol dependence were positively intercorrelated.

 Moderated mediation modeling indicated that metacognition fosters emotion and moderates the relationship between emotion and alcohol dependence in such a way that emotion and dependence are positively associated for high metacognition and are negatively associated for low metacognition.

The implications of the findings are discussed.

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RU21 – WV’s Underage Drinking Prevention and Social Marketing Project –is seeking ideas for its latest round of public service announcements.

West Virginia middle school, high school, and college students are invited to enter the 2011 PSA Challenge by submitting concepts for radio and television underage drinking prevention messages that emphasize “21 means 21.”

“Consumption of alcohol beverages by those under 21 is illegal,” said Stephanie Southall, WV’s Underage Drinking Prevention Specialist. “Research shows peer influence is the most effective strategy for creating a culture where underage drinking is NOT the norm. That’s why the RU21 PSAs are created and produced by West Virginia youth.”

ALL West Virginia students at the middle school, high school or college level are eligible to participate. Individuals or teams of up to 6 students may submit applications. More than 6 students may work together to develop scripts, but no more than 6 students from one organization will travel to Charleston for production. Each individual or group must have at least 1 (but no more than 2) adult sponsor(s).   > > > >   Read More

Impact of early life stress on alcohol consumption and on the short- and long-term responses to alcohol in adolescent female rats

We examined the interaction between early life stress and vulnerability to alcohol in female rats exposed to prenatal restraint stress (PRS rats).

First we studied the impact of PRS on ethanol preference during adolescence. PRS slightly increased ethanol preference per se, but abolished the effect of social isolation on ethanol preference.

We then studied the impact of PRS on short- and long-term responses to ethanol focusing on behavioral and neurochemical parameters related to depression/anxiety.
PRS or unstressed adolescent female rats received 10% ethanol in the drinking water for 4 weeks from PND30 to PND60.

At PND60, the immobility time in the forced-swim test did not differ between PRS and unstressed rats receiving water alone. Ethanol consumption had no effect in unstressed rats, but significantly reduced the immobility time in PRS rats. In contrast, a marked increase in the immobility time was seen after 5 weeks of ethanol withdrawal only in unstressed rats.

Hippocampal levels of neuropeptide Y (NPY) and mGlu1a metabotropic glutamate receptors were increased at the end of ethanol treatment only in unstressed rats. Ethanol treatment had no effect on levels of corticotropin-releasing hormone (CRH) in the hippocampus, striatum, and prefrontal cortex of both groups of rats.

After ethanol withdrawal, hippocampal levels of mGlu1 receptors were higher in unstressed rats, but lower in PRS rats, whereas NPY and CRH levels were similar in the two groups of rats.

These data indicate that early life stress has a strong impact on the vulnerability and responsiveness to ethanol consumption during adolescence.

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Alcoholism: A Modern Look at an Ancient Illness

Alcohol dependency (alcoholism) has existed throughout recorded history. It remains a highly stigmatized illness, looked down on by society, the patients themselves, and the medical establishment.

Science defines alcoholism as a primary progressive illness with a powerful genetic predisposition, highly amenable to intervention, evaluation, and treatment, and responsive to continuing care like other chronic illnesses.

Society, led by an educated medical community, needs to revisit the disease of alcoholism, challenge its outdated assumptions and prejudices, and embark on a new course with the goals of positively affecting these patients, their families, and communities and improving the nation's health.

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Alcohol Use Screening and Case Finding: Screening Tools, Clinical Clues, and Making the Diagnosis

This article presents an evidence-based approach to screening and case finding for alcohol use disorders in primary care.

Problematic alcohol use by both adults and adolescents is considered.

For clarity, this evidence-based presentation is divided into 6 sections: (1) epidemiology of alcohol use disorders, (2) associated health problems, (3) US Preventive Services Task Force screening recommendations, (4) screening/case finding instruments, (5) screening/case finding strategies, and (6) summary.

This article reviews the state-of-the-art, evidence-based concepts and practices for screening and case finding for alcohol use disorders among adults and adolescents in primary care settings.

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Brief Interventions for Alcohol Misuse

Alcohol misuse harms individuals and society with massive biopsychosocial and economic consequences: decreased worker productivity, increased unintentional injuries, aggression and violence against others, and child and spouse abuse.

The US Preventive Services Task Force recommends brief interventions for reducing alcohol misuse by adults, including pregnant women.

Systematic methods of screening and delivering brief interventions are needed in health care settings.

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Wednesday, March 2, 2011

Acceptance of Private Health Insurance in Substance Abuse Treatment Facilities

In 2008, nearly two thirds (65 percent) of substance abuse treatment facilities accepted some private health insurance as a form of client payment. 

Facilities with a primary focus of providing mental health services (85 percent), general health care (82 percent), or a mix of mental health services and substance abuse treatment (78 percent) were more likely than facilities with a substance abuse treatment focus (56 percent) or other focus (37 percent) to accept private health insurance. 

Facilities that accepted private health insurance were more likely than those that did not to accept adolescents into treatment (58 vs. 33 percent). 

Facilities in urban areas were less likely than facilities in non-urban areas to accept private health insurance. 

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Managing Drug and Alcohol Prevention and Treatment Services

Harmful drug and alcohol use is a major social issue with an estimated annual cost to the community of $14 billion. More than 77 000 Victorians are hospitalised for alcohol and drug related conditions each year. Around 27 000 enter government-funded specialist alcohol and other drug (AOD) treatment programs. 

The current community-based alcohol and drug program guided by harm minimisation principles has operated since 1997. This program funds activities designed to prevent and treat harmful drug and alcohol use. The state allocated $135.7 million for AOD prevention and treatment activities in 2010–11. Of this, $110 million, or 81 per cent is allocated to treatment and 19 per cent to prevention activities.

Typically, prevention initiatives are one-off projects, such as media campaigns, with few prevention services funded on an ongoing basis. In contrast there are 105 services providing treatment services to those who use AODs harmfully.

This audit examines the effectiveness of drug and alcohol prevention and treatment services overseen by the Department of Health (the department), with a particular focus on quality and accessibility of services, and the extent to which interventions work.

Dealing with harmful alcohol and drug use is particularly difficult due to the complexity of addiction, which is a chronic condition where individuals are prone to relapse. A simple ‘cure’ cannot be prescribed. Because of this, prevention and treatment programs need to be reviewed regularly and refined to adapt to changing community needs and to maximise their chances of success.

At its inception the new community-based alcohol and drugs program was innovative in both its service and funding model. However, 13 years later, the problems with treatment services that it was designed to overcome have not been resolved. 

The department has no assurance that the service system objectives of effective case management and continuity of care for clients and consistent, high quality services, are being achieved. Treatment services remain difficult for clients to access and navigate, and do not provide seamless pathways to other health and social support services. 

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An alcohol policy alliance for Southern Africa under formation

In the end of November 2010 NGO representatives from Southern and Eastern countries met in Kampala, Uganda for a training of trainers session on evidence-based alcohol policies. Representatives from organisations in Namibia, Botswana, Malawi, Lesotho and South Africa used this opportunity to discuss the formation of an alcohol policy alliance for the region.

A first step towards such an alliance was taken by the election of an interim board. Smart Kachipare srepresenting Blue Cross Botswana was selected chairperson of the interim Board. Other members are Nelson Zakeyu from Malawi; Mahao Lehloenya, Lesotho; Tania Diederiks, South Africa and Lovemore Mughandira, Namibia.  > > > >  Read More

Current alcohol consumption and its relationship to incident dementia: results from a 3-year follow-up study among primary care attenders aged 75 years and older

To investigate prospectively the relationship between current alcohol consumption (quantity and type of alcohol) and incident overall dementia and Alzheimer dementia.

The study is based on individuals (75+) attending general practitioners in Germany: 3,202 subjects free of dementia were studied at baseline, 1.5 years and 3 years later by means of structured clinical interviews including detailed assessment of current alcohol consumption and DSM-IV dementia diagnoses. Associations between alcohol consumption (in grams of ethanol), type of alcohol (wine, beer, mixed alcohol beverages) and incident dementia were examined using Cox proportional hazard models, controlling for several confounders.

Incident overall dementia occurred in 217 of 3,202 participants over a mean follow-up period of 3 years. Significant relationships were found between alcohol consumption (prevalence at baseline: 50.0%) and incident overall dementia (adjusted hazard ratio (HR) 0.71, 95% CI 0.53–0.96), respectively, incident Alzheimer dementia (adjusted HR 0.58, 95% CI 0.38–0.89). With regard to quantity of alcohol and type of alcohol, all hazard ratios were found to be lower than 1.

In agreement with meta-analyses that include younger age groups, our study suggests that light-to-moderate alcohol consumption is inversely related to incident dementia, also among individuals aged 75 years and older.

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Systematic review of alcohol screening tools for use in the emergency department

To ascertain which alcohol screening tool is most accurate in identifying alcohol misuse in patients in the emergency department a systematic review of diagnostic cohort studies of appropriate alcohol screening tools was performed.

A thorough search of medical databases and relevant peer journals was conducted. Citation and author tracking was also utilised due to an initial paucity of relevant literature.

Seven relevant papers were identified from this search, which allowed a review of the quality of the following alcohol screening tools: the fast alcohol screening tool (FAST), the Paddington alcohol test (PAT), the rapid alcohol problem screen (RAPS-4) and the TWEAK (where TWEAK is an acronym of the first letter of the key words in the questions of this screening tool: tolerance, worried, eye-opener, amnesia, K (cut-down)).

The most sensitive screening tool within this review appears to be the FAST (93–94%), which has a specificity of 86–88% with a positive predicted value of 86–87%. Although the FAST appears to be the best for accurately identifying alcohol misuse within emergency department patients, it was assessed as a universal screening tool, and it may not be feasible (time or cost) to screen all who present to this service.

In contrast, the PAT has been developed to be used on a select population within the emergency department and has already been shown to be cost-effective.

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Alcoholics Anonymous and Other Twelve-Step Programs in Recovery

Recovery is a new way of life for many patients; a life without substances to alter their moods but with a major change improving the physical, psychological, and emotional stability with improved overall health outcomes.

The Twelve Steps of the Alcoholics Anonymous (AA) are the foundation of the AA, describing both the necessary actions and the spiritual basis for the recovery program of the AA.

The Twelve Steps of the AA provide a structure for which a patient with alcoholism may turn for an answer to their problem of alcohol use, abuse, or dependence.

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