August 29, 2017

Opioid Overdose Deaths Double in 7 Years

A study of the growing United States opioid epidemic reveals that deaths from overdoses have nearly doubled over the past seven years, while increasing acute care costs and hospitalizations are taxing health care systems.

The paper, "The Critical Care Crisis of Opioid Overdoses in the United States" published in the Annals of the American Thoracic Society is believed to be the first to quantify the impact of opioid abuse on critical care resources in the U.S. The findings reveal that opioid-related demand for acute care services has outstripped the available supply.

In the cohort study, researchers from Ben-Gurion University of the Negev (BGU) in Israel, Harvard Medical School and University of Chicago analyzed nearly 23 million adult hospital admissions at 162 hospitals in 44 states over a seven-year period: January 1, 2009 through September 30, 2015. Among the more than 4 million patients requiring acute care, the researchers found 21,705 who were admitted to intensive care units (ICU) due to opioid overdoses. Admissions included overdoses for prescription drugs, methadone or heroin.

Opioid Admissions Up 34 Percent

"We found a 34 percent increase in overdose-related ICU admissions while ICU opioid deaths nearly doubled during that same period," according to Dr. Lena Novack, Ph.D., a lecturer in BGU's School of Public Health. The mortality rates of these patients climbed at roughly the same rate, on average, with a steeper rise in deaths of patients admitted to the ICU for overdose after 2012.

The average cost of care per ICU overdose admission also rose significantly - 58 percent - from $58,517 in 2009 to $92,408 in 2015. In addition, the study indicated that opioid-related ICU admissions increased an average of more than half a percent each year over the seven-year timeframe, jumping from seven percent to 10 percent by the end of the study period.

Patients admitted to the ICU due to an overdose increasingly required intensive care, including high-cost renal replacement therapy or dialysis.

Community Emergency Response

Admissions were identified using the Clinical Data Base/Resource ManagerTM of Vizient, Inc., which is comprised of data mainly from urban academic medical centers and may not reflect overdose-related acute care needs in other settings.

"Our estimates may actually be on the low side," Dr. Novack says. Since our team of researchers analyzed admissions rather than a manual chart review, we may not have captured every admission if opioid-related complications weren't coded as such."

The study also did not determine whether increased ICU admissions for opioid overdoses resulted from improved community emergency response that may have saved lives but then required critical care, or whether the increased ICU admissions indicated that community emergency response needs improvement so patients require a less intensive hospital care.

States With the Highest Opioid Hospitalizations

The researchers found that Massachusetts and Indiana have the highest opioid admission densities in the nation. Pennsylvania experienced the sharpest rise in opioid-related overdoses during the study period, with critical care overdose admissions nearly doubling since 2009. Illinois, California, New York, and Indiana have also experienced ICU admission rate increases during the period.

"Our findings raise the need for a national approach to developing safe strategies to care for ICU overdose patients, to providing coordinated resources in the hospital for patients and families, and to helping survivors maintain sobriety following discharge," the researchers conclude.

Posted by Webmaster at 08:39 AM


August 21, 2017

Peer Influence Doubles Teen Smoking Risk

Peer influence has long been known as a major risk factor for adolescent smoking, but findings have varied about how big the risk is or how this dynamic unfolds. A new, rigorous meta-analysis of 75 longitudinal teen smoking studies finds that having friends who smoke doubles the risk that children ages 10 to 19 will start smoking and continue smoking. It also found that peer influence is more powerful in collectivist cultures than in those where individualism is the norm.

There has been a great deal of research about peer influences on adolescents, says the study's senior author, Dolores Albarracín, PhD, a professor of psychology at the University of Illinois at Urbana-Champaign, but often findings rely on individual studies. "Meta-analysis is a summary of all we know," she says, "giving us a more reliable, robust number that is better supported by the facts."

"One of our most intriguing findings is that culture actually matters in how much influence adolescents have on their peers," says the study's lead author, Jiaying Liu, PhD, a recent graduate of the Annenberg School for Communication at the University of Pennsylvania. "Meta-analysis allowed us to examine studies from across the globe. We predicted that people in collectivistic cultures would be more likely to be influenced by peers around them, and that held true. In those most collectivistic countries, adolescents whose peers smoke are 4.3 times more likely to pick up smoking compared to people who have no peers smoking. By contrast, having peers who smoke made adolescents from those most individualist countries 1.89 times more likely to smoke."

Peer Influence Stronger in Some Cultures

The study included data from 16 countries, both collectivistic -- for example, China, South Korea, Jordan and Portugal -- and individualistic like the United States, Australia, Canada, the Netherlands and the United Kingdom.

The authors also examined the ethnic origins of the adolescents in each study, regardless of nationality. "We found that peer influence was much weaker in samples with higher proportions of adolescents with a European background, but much stronger in samples with higher proportions of adolescents with an Asian background," Liu says.

This finding about ethnic and cultural background may also explain why the results of teen smoking studies have varied in how big an effect peer influence has.

Closer Friends Have Biggest Influence

In addition, the study found that closer friends were more likely to influence peers to start smoking when compared to more distant friends. The closeness of peer friendships did not impact whether adolescents who smoke continued to smoke, however, indicating that perhaps the addictive nature of tobacco was an overriding factor.

The study was also able to better avoid what is often seen as the "chicken or the egg" problem of peer influence smoking studies: Do teens influence one another to smoke, or do those who smoke simply tend to become friends?

"By including only longitudinal studies, where peer influence was measured at an earlier time and adolescent smoking outcomes at a later date, we were better able to establish that peer influence led to the adolescent smoking outcomes, rather than the other way around," says Liu, who will be starting in the fall as an assistant professor in the University of Georgia's Department of Communication Studies.

Kids Need to Build Refusal Skills

The researchers hope that by providing a better understanding of the risk factors for teen smoking, they can help inform more targeted prevention efforts. By knowing who is most at risk, parents and public health officials alike can give teenagers the tools to resist tobacco.

"It's not enough just to say, 'Don't smoke it's bad for you,'" says Albarracín. "How are teenagers going to deal with temptation on a daily basis? We need much more specific campaigns dealing with normative influence -- for example, pointing out how many adolescents don't smoke. There can be more messaging in schools and training for parents on how to build refusal skills in their children."

Peer influence is particularly strong in the adolescent years, as children reduce the amount of time spent with parents and increase the amount of unsupervised time spent with peers.

Best to Start Prevention Early

"This work highlights the importance of considering the networks that surround teens, not just thinking about individuals in isolation," says co-author Emily Falk, PhD, associate professor at Penn's Annenberg School for Communication and director of its Communication Neuroscience Lab. "Behaviors spread from person to person, and keeping that in mind is essential for prevention and cure."

"The burden of smoking-caused morbidity is heavy around the world," Liu adds. "If social influence is a crucial factor in adolescents' decisions to start smoking and keep smoking, we want to understand how to leverage its power for better smoking prevention. It's always easier to stop people from starting to smoke than to change their behavior later in life."

The study was published in the journal Psychological Bulletin.

Posted by Webmaster at 12:22 PM


August 18, 2017

Smoking Can Increase Frailty in Older Adults

Smokers can greatly lower their risks of becoming frail as they grow older by quitting, even in old age. Old adults who smoke tobacco run a 60 percent greater risk of becoming frail in their later years.

British researchers have found that current smoking in older people increases the risk of developing frailty, compared with former smokers and never smokers. Former smokers, even those who quit in the past 10 years, did not appear to be at higher risk.

Smoking increases the risk of developing a number of diseases, such as chronic obstructive pulmonary disease (COPD), coronary heart disease, stroke and peripheral vascular disease, all of which can potentially have negative effects on people's physical, psychological and social health.

Frailty a Precursor to Disability

Frailty is considered a precursor to, but a distinct state from, disability. Frailty is a condition associated with decreased physiological reserve and increased vulnerability to adverse health outcomes. The outcomes include falls, fractures, disability, hospitalisation and institutionalisation. Frailty has also been shown to be linked to worse psychological or cognitive outcomes, such as poor quality of life and dementia.

Due to the potential for reversibility of frailty, identifying potentially modifiable risk factors of frailty may help to develop strategies to prevent or slow progression of adverse health outcomes associated with both frailty and smoking.

Researchers aimed to examine the association of smoking with the risk of developing frailty, controlling for important confounding variables and using data from a nationally representative sample of older men and women living in England.

The Components of Frailty

Researchers defined frailty using a combination of five physical frailty components:

  • unintentional weight loss
  • self-reported exhaustion
  • weakness
  • slow walking speed
  • low physical activity

Frailty is classified as having three or more of the five criteria.

The current study used data of participants who were aged 60 years or older. The final sample for this study was 2,542 participants, divided into two groups: current smokers and non-smokers. The non-smokers were further divided into another two groups: past smokers and never smokers. The past smokers were once again divided into two groups: those who quit within the last 10 years and those who quit more than 10 years ago. The analysis revealed that current smoking was associated with an approximately 60% increased risk of developing frailty.

There was, however, no significant association between past smoking and incident frailty in any models. Among 1,113 past smokers, 157 quit smoking within the last 10 years and 956 quit smoking for more than 10 years ago. Incident frailty risks of these two groups were not significantly different from that of never smokers in all models.

COPD Strongly Linked to Frailty

When COPD was added to the model, current smoking was no longer a significant predictor of incident frailty. In this model, COPD was strongly associated with incident frailty. These findings suggest that current smokers are more likely to develop frailty due to COPD, rather than smoking itself.

Given that smoking is a modifiable lifestyle factor, and smokers who quit did not appear to be at high risk for frailty, this research suggests that smoking cessation may potentially prevent or delay developing frailty, even in old age.

"Our study showed that current smoking is a risk factor of developing frailty. Additional analyses revealed that COPD seems a main factor on the causal pathway from smoking towards frailty," said the study's author, Gotaro Kojima, "but those who quit smoking did not carry over the risk of frailty."

The study was published in Age & Ageing, the scientific journal of the British Geriatrics Society.

Posted by Webmaster at 07:29 AM


August 17, 2017

Some Prevention Efforts Can Actually Backfire

Some prevention campaigns aimed at stopping young drinkers from risky drinking habits can actually backfire if not worded properly.

Campaigns designed to stop young people "bolting" drinks can be ineffective and can even make them more likely to do it, new research suggests. Scientists from the University of Exeter and the University of Queensland examined reactions to a poster warning of the consequences of bolting (downing an alcoholic drink in one) and found it had no effect on people's future intentions.

Correcting Misperceptions

And when a statement was added saying other people disapproved of bolting, study participants reported stronger intentions to bolt in the future.

However, changing this to a message saying most people "do not bolt drinks on a night out" was effective.

"Many young people overestimate the extent to which their peers both approve of and engage in risky drinking behaviors," said study author Dr Joanne Smith, of the University of Exeter.

"One way to tackle risky drinking is to try to correct these misperceptions through health campaigns, such as posters.

Some Messages More Effective

"In our research, we wanted to explore what kinds of messages are more effective in changing people's intentions to bolt.

"Our results highlight the potentially harmful effects of exposure to what's called an 'injunctive norm' - a message about the approval or disapproval of others.

"Meanwhile, a 'descriptive norm' - telling people what others do rather than what they think - had a positive impact."

The study is published in the journal Addiction Research and Theory.

Poorly Designed Campaigns Can Backfire

Professor Charles Abraham, of the University of Exeter Medical School, said: "This demonstrates how careful we need to be in selecting the right message in campaigns, and evaluating them before wider dissemination, as poorly designed campaigns, however well-intentioned, can backfire."

The research consisted of three studies, in which volunteers (221 in total) saw the poster or did not, and then either received or did not receive messages about what their peers thought or how they behaved.

In one study, some participants received an accurate message saying 70% of their peers "disapprove of bolting", and in another some received an accurate message saying 65% of their peers "do not bolt drinks on a night out."

Drinking Responsibly

They all then completed identical questionnaires to measure their perceptions of group norms related to bolting, and their own intentions to do it in the future.

The researchers point out that beliefs about how other people behave are often the "best predictor" in terms of general drinking behavior and binge drinking, but note that using these beliefs to change behavior needs to be done carefully to ensure campaigns have the desired effect.

The paper is entitled: "Normative feedback in alcohol-related health promotion: When and how does normative feedback reduce intentions to drink irresponsibly?"

Posted by Webmaster at 09:50 AM


August 16, 2017

Early Brain Injury Linked to Alcoholism

Researchers at Ohio State University have surveyed previous studies to investigate the relationship between traumatic brain injuries and alcohol abuse. They found evidence that traumatic brain injuries in children and adolescents could be a risk-factor for alcohol abuse in later life.

When we think of the link between alcohol and traumatic brain injuries, we probably think of a person's increased risk of injury while drunk. Alcohol intoxication is indeed a significant risk factor for traumatic brain injuries, and one study has reported that alcohol use is involved in as many as 50% of emergency department admissions for traumatic brain injuries in the US.

More Susceptible to Alcohol Abuse

Intriguingly, an animal study conducted by Zachary Weil, a researcher at Ohio State University, made him suspect that the converse might also be true, particularly in young people. "We recently reported that mice that experience a traumatic brain injury as juveniles drink significantly more alcohol as adults," says Weil. "When we started to look at the human literature it became clear that alcohol and traumatic brain injuries were very connected. There were some hints that brain injuries might actually make someone more susceptible to alcohol abuse."

Weil was inspired to look more closely at the past literature, and what he and his team found was recently published in Frontiers in Behavioral Neuroscience. The researchers found that it was difficult to tell if their hypothesis was true in adults. "So many adults that have brain injuries are already heavy drinkers and therefore it's really hard to tell for sure if a brain injury has affected their drinking," explains Weil.

Brain Injury Affects Other Factors

However, for people who suffer a traumatic brain injury in childhood or adolescence, there was a clearer link to alcohol abuse problems in later life. For example, children under 5 years of age who suffer a traumatic brain injury are over 3.6 times more likely to exhibit substance abuse as teenagers, compared with uninjured children.

So, why would a traumatic brain injury potentially lead to alcohol abuse? The team found evidence in the literature that brain injury can negatively affect factors that are associated with reducing alcohol abuse. For example, forming stable romantic relationships, getting involved in extracurricular activities and maintaining full-time employment are all associated with a reduced risk of substance abuse, but all are less likely in brain injury survivors.

More Impulsive, Less Aware

Traumatic brain injuries can also make people more impulsive and less aware of the consequences of their actions, and there is also evidence that brain injury survivors may use alcohol to help deal with the negative consequences of their injury.

Beyond its psychological effects, traumatic brain injury can cause significant inflammation in the brain. Alcohol also generates neuroinflammation, and evidence from animal studies suggests that this inflammation might drive further drinking.

Other Potential Factors in Alcohol Abuse

Finally, traumatic brain injuries can damage specific neurochemical systems in the brain that are vulnerable during childhood development, such as the dopaminergic system. A dysfunctional dopaminergic system is a risk factor for substance abuse, suggesting another potential link between childhood brain injury and alcohol abuse in adulthood.

So, how can we address the problem? "This is an important issue because drinking after brain injury is associated with health problems and poorer outcomes. Specifically targeting substance abuse problems in the brain-injured population could do a lot of good," says Weil.

The researchers caution that the link between brain injuries and alcohol abuse has not yet been completely established and more work is needed. "This has not been completely confirmed in humans, but there is a lot of suggestive evidence," explains Weil.

Posted by Webmaster at 07:51 AM


August 15, 2017

Intoxication Increases Risk of Domestic Violence

Intoxicated, heavy drinkers have a tendency to act rashly in response to negative emotions, which can intensify the risk for intimate partner aggression, according to a study by Georgia State University and Purdue University.

The researchers examined the link between risk-promoting factors, such as impulsivity and problematic drinking, and intimate partner aggression among intoxicated and non-intoxicated heavy drinkers.

Intimate Partner Aggression

To be considered a heavy drinker, participants had to report typically consuming at least five standard drinks for men or four standard drinks for women per drinking day at least twice per month during the past year.

The study suggests acute alcohol intoxication is a key facilitator of the association between problematic drinking patterns and intimate partner aggression. It's only under acute intoxication that problematic drinkers are more likely than non-problematic drinkers to perpetrate intimate partner aggression.

Olivia Subramani, first author of the study and a Ph.D. student in clinical psychology at Georgia State, offered an explanation for why alcohol intoxication exerts these effects.

Implusive Emotional Responses

"People who respond impulsively to their emotions likely do so because they tend to pay more attention to emotional cues in the situation (for example, a mean look from one's partner)," Subramani said. "This 'tunnel vision' for emotional cues is exacerbated when people are drunk, so they are focused almost exclusively on the aggression-promoting cues in the situation. This makes aggression an especially likely response."

The findings, published in the journal Alcoholism Clinical & Experimental Research, make important contributions about the conditions most likely to result in committing intimate partner aggression.

"Our findings shed light on one way that alcohol may cause intimate partner aggression, particularly among people who are already at high risk for perpetration," said Dr. Dominic Parrott, professor of psychology at Georgia State and co-author of the study. "These results suggest that interventions which aim to reduce alcohol use or help people to focus on cues that inhibit, rather than promote, aggression are most likely to be effective."

Aggression-Inhibiting Cues

Participants in this study, recruited from Atlanta and Indianapolis, were 249 heavy drinkers (148 men and 101 women) in heterosexual relationships with a recent history of psychological or physical intimate partner aggression toward their partner.

The study's results support alcohol use as an important target for the treatment of intimate partner aggression. When a person is acutely intoxicated, it could also be effective to distract them from aggression-promoting cues and redirect their attention onto aggression-inhibiting cues, such as peaceful images or themselves, the researchers said.

Posted by Webmaster at 12:02 AM


August 14, 2017

Quitting Smoking More Difficult for Some

Psychologists are finding some success with treatments aimed at helping smokers from underserved groups, including racial and ethnic minorities and those with psychiatric disorders.

Quit Smoking Help

In the Journal of Consulting and Clinical Psychology, published by the American Psychological Association, researchers report on several effective treatments that may help these smokers in an effort to increase national smoking cessation rates. The percentage of American smokers rose from 19.8 percent in 2007 to 20.6 percent in 2008, after a 10-year steady decline in smoking rates, according to the latest figures from the Centers for Disease Control and Prevention.

"One of the reasons smoking rates have remained stagnant is because these underserved groups of smokers have not been adequately targeted by research and treatment," said the special section editor, Belinda Borrelli, PhD, who is with the Centers for Behavioral and Preventive Medicine at Brown University Medical School. Underserved smokers include those who have a 10 percent higher smoking rate than the general population, have less access to treatments, and are more likely to be excluded from long-term treatments trials, according to Borelli.

In one article, researchers found that success in stopping smoking differed for different psychiatric disorders. For example, compared to smokers with no psychiatric disorders, smokers who had an anxiety disorder were less likely to quit smoking six months after treatment.

In the same article, researchers found that people's barriers to quitting were directly related to what type of psychiatric disorder they had. For example, smokers who had ever been diagnosed with an anxiety disorder reported a strong emotional bond with their cigarettes while smokers ever diagnosed with a substance use disorder reported that social and environmental influences were especially likely to affect their smoking. "This information may help clinicians gauge relapse risk and identify treatment targets among smokers who have ever had psychological illnesses," said lead author Megan Piper, PhD, from the University of Wisconsin School of Medicine and Public Health.

Comparing Treatment

Evidence-based smoking cessation treatments are addressed in another article in this special section. Researchers from the University of Miami looked at the effect of intensive cognitive-behavioral therapy on African-American smokers. They placed 154 African-American smokers wearing nicotine patches into one of two six-session interventions. Participants in the group using cognitive-behavioral techniques were taught relapse prevention strategies and coping skills, along with other techniques. The other group participated in a health education series that explained general medical conditions that are associated with smoking, such as heart disease and lung cancer.

Compared with general health education, participation in cognitive-behavioral therapy sessions more than doubled the rate of quitting at a six month follow-up, from 14 percent to 31 percent the researchers found. "We know cognitive-behavioral therapy helps people quit, but few studies have examined this treatment's effect on African-American smokers," said the study's lead author, Monica Webb, PhD, of the University of Miami. "Hopefully, our findings will encourage smoking cessation counselors and researchers to utilize cognitive-behavioral interventions in this underserved population."

Secondhand Smoke Study

Borrelli, the section editor, examined another minority group—Latinos. She measured the amount of second-hand smoke in participants' homes and gave feedback to smokers about how much smoke their child with asthma was exposed to. For example, they were told that their child was exposed to as much smoke as if the child smoked 'x' number of cigarettes him- or herself during the week of the measurement – this was the experimental group. Smokers in the control group underwent standard cognitive-behavioral treatment for smoking cessation. Smokers in the experimental group were twice as likely to quit as the control group, Borrelli found. "The child's asthma problems may provide a teachable moment for parents whereby they become more open to the smoking cessation messages," Borrelli said. "Providing treatment that is focused on the health needs of the family, and delivered in a culturally tailored manner, has the potential to address health care disparities for Latino families."

Posted by Webmaster at 03:45 AM


12 Steps Improve Youth Treatment Outcomes

A treatment program for adolescents with substance-use disorder that incorporates the practices and philosophy of 12-step programs like Alcoholics Anonymous (AA) produced even better results than the current state-of-the art treatment approach in a nine-month, randomized trial.

The results of the study, led by a Massachusetts General Hospital (MGH) psychologist, are published online in the journal Addiction.

"While all adolescents can improve when they receive well-articulated substance-use disorder treatment, we showed that adding a 12-step component to standard cognitive-behavioral and motivational strategies produced significantly greater reductions in substance-related consequences during and in the months following treatment," says John Kelly, PhD, director of the Recovery Research Institute in the MGH Department of Psychiatry, who led the study. "It also produced higher rates of 12-step meeting participation, which was associated with longer periods of continuous abstinence."

Combining Treatment Approaches

While it is common for adolescent treatment programs in the U.S. to link patients to mutual-help organizations like AA, Narcotics Anonymous (NA) or Marijuana Anonymous (MA), the effectiveness of combining 12-step approaches with motivational enhancement/cognitive-behavioral therapies has not been clear because there has been no well-defined treatment protocol integrating both approaches for young patients.

The intervention developed by the team was based on motivational/cognitive-behavioral approaches but also included information about and the kinds of discussions featured in 12-step program meetings.

Conducted at the MGH Center for Addiction Medicine, the study enrolled 59 participants, ages 14 to 21, who met substance-use disorder criteria and had been actively using within the past 90 days. Participants were randomly assigned to either a standard motivational enhancement/cognitive behavioral program or the Integrated Twelve-Step Facilitation (iTSF) program.

Reducing Relapse Risk

Both programs featured 10 consecutive weekly sessions -- two individual sessions with a therapist and eight group sessions. The motivational enhancement/cognitive-behavioral approach was designed to enhance adolescents' motivation for change towards remission and recovery. Sessions focused on teaching and practicing cognitive-behavioral relapse prevention and coping skills and included setting and reporting on weekly treatment goals.

Group sessions for the iTSF group included discussions of topics such as changing social networks and reducing relapse risk. Two of the sessions featured young members of NA or MA who shared their own experiences with addiction and recovery.

"That peer-to-peer aspect was probably the most powerful in disabusing young people of the negative stereotypes they often hold about 12-step members and about recovery more broadly," says Kelly. "Similar-aged peers who are in recovery seemed much better able to capture the attention of participants than clinic staff."

Fewer Substance-Related Consequences

Along with the weekly reports at their sessions, participants were formally assessed upon entering the study and then three, six and nine months later. At the end of the study period, both groups showed similar improvements in the primary outcome, percent days abstinent. But those in the iTSF group had greater attendance at 12-step meetings during the three months that included the intervention.

Participants in the iTSF group also reported significantly fewer substance-related consequences - things like feeling unhappy, guilty or ashamed because of their substance use; neglecting responsibilities; taking risks; having money problems; damaging relationships with family and friends, and having under-the-influence accidents.

The fact that the greater rate of 12-step attendance among the iTSF group was not maintained after the intervention program may indicate the need for a longer treatment program or regular, follow-up visits.

Longer Term Care Needed

"We want to replicate and extend the testing of this treatment even further to determine the benefits of longer term care," Kelly explains. "We know that the transition to adulthood is fraught with relapse risks for young people recovering from a substance-use disorder, so some kind of regular but brief 'clinical recovery check-up,' like what is common for other chronic conditions like diabetes or hypertension, could improve outcomes."

Kelly, who is the Elizabeth R. Spallin Associate Professor of Psychiatry in the Field of Addiction Medicine at Harvard Medical School, adds, "In countries like the U.S., the greatest health risks for young people by far are from alcohol or other drug use. Cognitive-behavioral and motivational programs are evidence-based, popular approaches for addressing youth substance-use disorder, and now these data suggest that integrating these approaches with 12-step philosophy and practices can further help reduce the impact of substance use in their lives and potentially facilitate higher rates of abstinence.

"Given the prevalence of substance-use disorders among young people, having treatments that are both effective and cost-effective -- linking patients to free and ubiquitous community resources -- is needed and welcome."

Posted by Webmaster at 03:40 AM


Teen Binge Drinking Affects Cognitive Skills

Drinking alcohol, is a well-engrained and long-standing social habit in many countries around the world, even though the fact that alcohol has an impact on one's health is largely established, especially when it comes to heavy drinking.

In particular, adolescents are known to enjoy their drinking games and nights-out without worrying much about the effects alcohol can have on their health. In fact, drinking in high quantities is common during adolescence with nearly 25% of high school seniors in the US reporting that they got drunk in the last 30 days.

The effects of heavy drinking among young people on the brain have been looked at closely in a mini review published in Frontiers in Psychology by Anita Cservenka, Assistant Professor at Oregon State University et.al.

Harmful Effects of Binge Drinking

"Adolescence is a time when the brain still matures including not only biological development but also maturation of psychosocial behaviours. Given the increase of binge and heavy drinking in young people, understanding the effects of consuming large quantities of alcohol on neural development and the impact on cognitive skills is very important" says Assistant Professor Cservenka.

Binge or heavy episodic drinking means four or more standard drinks within a two-hour drinking session for females, five or more drinks for males. The review highlights existing research that examines the harmful effects of such drinking habits with a view to inform future studies.

"We looked at six areas to determine the deleterious impact of heavy drinking on brain response, namely: response inhibition, working memory, verbal learning and memory, decision making and reward processing, alcohol cue reactivity, and socio-cognitive/socio-emotional processing" explains Assistant Professor Cservenka.

Affects Memory, Learning Skills

The review establishes that binge drinking among young people is associated with a thinning or reduction of areas of the brain that play a key role in memory, attention, language, awareness and consciousness, which include cortical and subcortical structures. Taking learning and memory as an example, studies have shown that heavy drinking leads to a deficit in the ability of young people to learn novel words, which has been linked to changes in brain activity.

Looking to the future, "these brain alterations, as a result of heavy alcohol use during adolescence and young adulthood, could result in increased risk of developing an alcohol use disorder later on in life. It is therefore important to continue raising awareness of the risks of binge drinking and to promote future research in this area. Our review provides a useful basis to determine the areas that require further attention." concludes Assistant Professor Cservenka.

Posted by Webmaster at 03:35 AM


Alcohol Increases Risk of Digestive Cancers

Citizens across the EU are consuming an average of two alcoholic drinks per day, placing drinkers at a 21% increased risk of developing colorectal cancer, in addition to other digestive cancers, a report finds.

The report, launched today by United European Gastroenterology, revealed that the average daily intake of alcoholic drinks was 'moderate' (between 1 and 4 drinks per day) in all 28 EU states, placing these citizens at a heightened risk of both colorectal and oesophageal cancer.

3 Million Deaths Per Year

'Heavy' drinkers (people that consume more than 4 drinks per day) were found to be at an increased risk of pancreatic, liver and gastric cancer. These three cancers, coupled with colorectal and oesophageal cancer, are the five most common digestive cancers worldwide, causing almost three million deaths per year and contributing to over a third of global cancer deaths.

No countries within the EU were found to have 'light' alcohol consumption (on average, less than 1 alcoholic drink per day per capita).

The European Alcohol Endemic

Alcohol consumption across the European region is higher than in any other region in the world, with over one fifth of the European population over the age of 15 drinking heavily at least once a week. As a result, the continent suffers from the highest proportion of ill health and premature death directly linked to alcohol.

Despite high levels of consumption throughout Europe, research shows that as many as 90% of people are unaware on the link between alcohol and cancer.

In light of these alarming statistics, tackling the harmful use of alcohol is a main priority for the upcoming Estonian presidency of the Council of the European Union.

How to Tackle Europe's Alcohol Crisis

Consumers are provided with mixed-messages on recommended units, glasses and volumes of alcohol. UEG are therefore calling for a pan-European approach to the provision of clear and consistent information about the health risks of drinking alcohol to help eradicate confusion on appropriate levels of consumption.

Professor Markus Peck, leading digestive health expert, comments; "One of the main challenges in addressing high drinking levels is how deeply embedded alcohol consumption is within the European society, both socially and culturally. Political action like minimum pricing and reducing access to alcohol needs to be taken now to prevent many future casualties. Research then has to follow to help generate data and allow us to fine-tune future political activity".

Increased pressure on the alcohol industry to develop clear and responsible labeling, together with a tightening of regulations on the marketing of alcohol, are other important steps outlined within the report to help tackle the crisis. France is a country leading the way in this regard, where stricter marketing, coupled with regulations for drinking at work, has contributed to a decline in alcohol consumption and digestive cancer incidence as a result.

Posted by Webmaster at 03:29 AM


Legal Marijuana Laws Affect Teen Use

A study by researchers at Dartmouth has found that adolescents living in medical marijuana states with a plethora of dispensaries are more likely to have tried new methods of cannabis use, such as edibles and vaping, at a younger age than those living in states with fewer dispensaries. The study will appear in the August issue of Drug and Alcohol Dependence.

"This study was driven by two motivations-- the need to understand if and how the shifting legal landscape of cannabis may affect kids, and the potential utility of social media as an epidemiological sampling method," says Jacob Borodovsky, a PhD candidate at The Dartmouth Institute for Health Policy and Clinical Practice and the Center for Technology and Behavioral Health, and the lead author of the study. "If it is true that certain components of legalization change the way young people use cannabis, then we need to devote more resources to understanding the important consequences (good or bad) of the specific provisions included in the diverse cannabis laws that are emerging across the country."

Potential Public Health Harm

Borodovsky and colleagues examined associations between provisions of legal cannabis laws (such as allowing dispensaries, home cultivation, etc.) and cannabis consumption patterns among youth using online surveys distributed through Facebook, which proved to be a reliable method for generating geographically diverse samples of specific subgroups of cannabis-using youth.

"Our data suggest a relationship between the degree of regulatory oversight of legal cannabis and kids' propensity for trying new ways of using cannabis," Borodovsky says. "I think we need to start having a broader national conversation about how best to design the production and distribution regulations for legal cannabis to mitigate potential public health harms."

Teens Vulnerable to Adverse Effects of Marijuana

As cannabis legalization rapidly evolves, in both medical and recreational usage, understanding the laws' effect on young people is crucial because this group is particularly vulnerable to the adverse effects of marijuana and possesses an inherent elevated risk of developing a cannabis disorder.

"Using social media to disseminate web surveys is a useful epidemiological research method. It allows us to quickly collect geographically diverse data on cannabis-related questions that aren't asked in the traditional federally-sponsored drug use surveys," Borodovsky says. "My hope is that we can use these and other types of results to create rational legal cannabis laws that are based on data rather than anecdotes."

Posted by Webmaster at 03:27 AM


Binge Drinking Linked to High Glucose Levels

Regular high alcohol consumption and binge drinking from age 16 is associated with higher glucose concentrations in women's blood - an important risk factor for type 2 diabetes - later in life, according to a study published in the open access journal BMC Public Health.

This study is the first to assess alcohol consumption data, starting in adolescence, over a 27 year period in relation to their blood glucose levels taken when they were 43 years of age. In women, total alcohol consumption and binge drinking behavior throughout the 27 year period was significantly associated with higher blood glucose levels independent of BMI, hypertension and smoking status at age 43.

Men Affected in Other Ways

This association was not true for men, for whom only BMI and hypertension remained associated with increased blood glucose levels.

Dr Karina Nygren, lead author from Umea University, Sweden said: "Our findings show that high alcohol consumption from ages 16 to 43 is associated with higher blood glucose levels in women but not in men. Because higher blood glucose is a risk factor for the development of type 2 diabetes, our data suggest that informing people about the risk of high alcohol consumption at a young age could have positive health impacts further down the line."

Despite the association between alcohol, binge drinking and blood glucose only being significant in women, men still had higher blood glucose levels than women and consumed nearly 3 times as much alcohol between ages 16 and 43.

Alcohol Increases Insulin Resistance

Previous studies suggest possible mechanisms for the association between alcohol and elevated blood glucose. For example, human studies have shown that ethanol can increase insulin resistance, which in turn leads to accumulation of glucose in the blood. Studies in rats have also shown that binge drinking behavior alters the rat's metabolism in a way that negatively affects insulin.

Dr Nygren commented: "Although there are some biological explanations behind why alcohol can directly lead to increased levels of glucose in the blood, the difference between men and women in our study is more difficult to explain."

Data included in this study come from the Northern Swedish Cohort study which began in 1981. A total of 897 people from this study answered a questionnaire about alcohol consumption when they were 16, 18, 21, 30 and 43 years old. At age 43 a blood sample was taken from each person to assess blood glucose levels.

Long-Term Insight Into Drinking Behavior

The questionnaire involved eight questions about alcohol consumption including questions such as "how often do you drink alcohol?" and how much do you drink at each occasion?". Binge drinking was defined as drinking four or more standard drinks of beer, wine or spirits per occasion for women, and five or more for men, at least once per month. One standard drink was specified to contain 12g of ethanol, which is equivalent to 330ml of a 5-6% beer.

The study shows an association between alcohol consumption and higher blood glucose but cannot show cause and effect. The data is limited by the fact that information on alcohol consumption comes from self-reported questionnaires and could be subject to bias. However, the long term nature of the study, which includes multiple follow ups, offers a unique insight into the drinking behaviors of people throughout their life.

Posted by Webmaster at 03:25 AM


Alcohol's Health Benefits Overstated?

The benefits of light alcohol consumption, as well as the risks associated with not drinking at all, might not be as great as previously thought, according to Penn State researchers who examined the drinking habits of middle-aged adults.

The researchers analyzed information about more than 9,000 people across England, Scotland and Wales born in 1958 who are participating in the longitudinal National Child Development Study. The study, based at the University College London Centre for Longitudinal Studies, tracked changes in people's drinking and cigarette smoking habits from age 23 to 55, and linked these changes to mental and physical health.

About one third of men and women who reported drinking at the light-to-moderate level were very unlikely to smoke. While this group of light drinkers and non-smokers enjoyed the best health and quality of life in middle age, three other groups experienced more health problems. These groups were those who drank lightly to moderately but also smoked; those who both drank more heavily and smoked; and those who refrained from drinking alcohol or reduced their drinking over time.

Other Risk Factors Not Considered

Light-to-moderate drinkers were defined as adults who consumed no more than 14 units of alcohol, which is equivalent to roughly six pints of beer or six medium-sized glasses of wine, per week. This is the current maximum recommended for men and women by the United Kingdom's Department of Health, according to Jeremy Staff, professor of criminology and sociology at Penn State and the study's lead author.

While the supposed benefits of moderate drinking have been widely reported in the media, many reports have failed to take into account other risk factors. For example, light-to-moderate drinkers suffered poor health in midlife if they were former smokers or still had the occasional cigarette. This may be due to a direct effect of smoking or because of other lifestyle-related risks, such as lack of exercise or obesity. Many midlife abstainers also began their adult life in poorer physical or mental health than peers who had completely abstained from alcohol.

Is There Harm in Abstaining?

"Alcohol abstainers are a diverse group. They include former heavy drinkers who quit due to problems with alcohol, as well as those who quit drinking due to poor health, and not just lifetime abstainers," said Staff. "Medical professionals and public health officials should be wary of drawing conclusions about the so-called 'dangers' of never drinking without more robust evidence."

About 1-in-5 members of 55-year-olds who said they had never drunk alcohol in their lives had previously reported drinking when they were younger. This suggests that those who drink very little may tend to misremember or under-report previous drinking habits. When studies include this group as lifetime abstainers, apparent 'harms' of abstaining may be overestimated, said the researchers.

Alcohol Has Many Health Risks

While modest drinking habits also have been linked with higher levels of education, those with few or no educational qualifications were also among those who did not drink or drank modestly. On the other hand, men and women with the highest educational qualifications at age 23 were more likely than their peers to drink at light-to-moderate rates throughout their adult lives, and were unlikely to smoke.

Jennifer Maggs, professor of human development and family studies at Penn State and another of the study's authors, added, "Evidence continues to grow that alcohol has many health risks, including for cancer. Therefore, it is dangerous to report only benefits of moderate alcohol consumption. Drinking habits are also shaped by our education, health earlier in life, and related lifestyle factors including smoking. These other influences may be the real factors underlying the connection between drinking and midlife health."

According to Sir Ian Gilmore, Chair of the Alcohol Health Alliance in the UK, "This study provides yet more evidence that any benefits associated with drinking alcohol are smaller than previously thought. The most effective ways to reduce harms associated with alcohol consumption are to introduce pricing measures linked to alcohol sales, and enable more informed choices through public education efforts and mandatory labeling of alcohol products."

Posted by Webmaster at 03:23 AM


Aggression Linked to Risk of Substance Abuse

People who have trouble controlling their anger are more likely to abuse alcohol and other substances. Those who display frequent aggressive behavior are at five times greater risk for abusing alcohol, tobacco and marijuana.

According to researchers at the University of Chicago Medical Center, patients with intermittent explosive disorder (IED) are much more likely to become substance abusers compared to those who do not display frequent aggressive behavior.

The study examined data from more than 9,200 subjects in the in the National Comorbidity Survey, a national survey of mental health in the United States.

Aggression Linked to Substance Abuse


The investigators found that as the severity of aggressive behavior increases so do levels of daily and weekly substance abuse. A history of frequent, aggressive behavior is a predictor of later substance abuse, they concluded.

IED is a condition marked by frequent physical or verbal outburts and affects an estimated 16 million people in the United States -- more than bipolar disorder and schizophrenia combined. It is typically diagnosed in adolescents, some as young as 11, long before substance abuse problems develop.

The condition runs in families and is generally treated as a social-behavior issue rather than a true neurobiological disorder with significant genetic components, said Emil Coccaro, MD.

More Than Simply Bad Behavior


"People don't see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn't. It has significant biology and neuroscience behind it," said Coccaro.

The Chicago study found no relationship between IED and the presences of other psychiatric disorders, as has been implied by previous research.

Although excessive alcohol use can clearly worsen aggressive behavior, Coccaro and colleagues found that IED diagnosis almost always precedes the development of chronic substance abuse. In cases where subjects were diagnosed with both disorders, IED preceded substance abuse in 92.5% of the cases.

Early Treatment Is Effective


The good news is if intermittent explosive disorder and aggression is treated early it can delay or even prevent substance abuse later in life. "Early psychological intervention, medication and cognitive therapy are the most effective treatments to prevent, or at least delay, substance abuse problems in adolescents diagnosed with IED," Coccaro said.

Source: Coccaro EF, et al. "Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample." Journal of Clinical Psychiatry Feb. 28, 2017

Posted by Webmaster at 03:21 AM


Strong Policies Lower Drunk Driving Deaths

Stronger alcohol policies protect young people from dying in crashes caused by drunk driving according to researchers at Boston Medical Center. The study, which is published online in the journal Pediatrics, supports the importance of comprehensive alcohol control policies to reduce the number of young people who die in alcohol-related crashes.

Motor vehicle crashes are a leading cause of death among young people in the United States. Forty percent of deadly car crashes involve a drunk driver in Massachusetts, and the state falls within the top twenty-five percent for rates of young people killed in a drunk driving crash.

"Half of all young people who die in crashes are driven by someone who has been drinking," says lead author Scott Hadland, MD, a pediatrician at BMC and the study's corresponding author. "But with stronger alcohol policies at the state level, we saw a significantly lower likelihood of alcohol-related deaths."

The Alcohol Policy Environment

The study used an alcohol policy scale that assessed 29 alcohol policies across the United States, which were designed to reduce alcohol consumption or prevent impaired driving, and cross referenced them with the number of people under 21 who died in crashes involving alcohol, approximately 85,000, over the course of 13 years. States were ranked based on how restrictive their alcohol laws were, including higher alcohol taxes and zero-tolerance policies for young people drinking and driving.

"We've seen research that shows the relationship between specific alcohol laws and drunk driving deaths, but no one has looked at the broader picture of the policy environment in different states," said Timothy Naimi, MD, MPH, a general internal medicine physician and alcohol epidemiologist at BMC who served as senior author of the study.

More Restrictive Laws, Fewer Deaths

Researchers found as state alcohol laws became more restrictive, the likelihood of a young person being killed in a drunk driving crash decreased and led to less alcohol consumption as a whole. Additionally, almost half of underage youth who died in alcohol-related crashes were passengers, not drivers; and about 80% of those passengers were being driven by adults aged 21 or older who had been drinking.

Most of the deadly crashes happened during the weekend, in the evening or at night. The impact of state alcohol policies on drunk driving deaths was consistent for males and females, and generally held for both drivers and passengers.

Alcohol Control Clearly Matters

"When it comes to preventing impaired driving and deaths of young people, alcohol control policies clearly matter," says Hadland, who is also an assistant professor of pediatrics at Boston University School of Medicine. "We found that those policies don't have to necessarily be ones that prevent drunk driving, or that specifically target young people."

"Since most young people who died as passengers in a car were driven by an adult over 21 who had been drinking, alcohol laws that prevent adult drinking are also critical," said Naimi who is also an associate professor of medicine and public health at Boston University School of Medicine and Public Health. "We must also focus on strategies that reduce excessive drinking, rather than focusing exclusively on interventions to prevent driving among those who are already impaired."

Posted by Webmaster at 03:19 AM


Trusting Counselor Vital to Treatment Success

A positive, trusting relationship between counselor and patient, known as a "therapeutic alliance," can be key to successful treatment of alcohol use disorder, a study finds. Gerard Connors, PhD, senior research scientist at the University at Buffalo Research Institute on Addictions, studied more than five dozen people engaging in a 12-week program of cognitive behavior therapy for alcohol use disorder.

Patients who reported the most positive relationships with their counselors on a session-to-session basis had fewer days of drinking and fewer days of heavy drinking between treatment sessions than patients whose relationship was not as positive.

Positive Relationship Yields Better Results

The results indicate that efforts to ensure a good match between patient and counselor can have considerable benefits to the patient's recovery, Connors says. Further research on what factors lead to strong therapeutic alliances in alcohol treatment could be warranted.

Historically, there was an expectation that the most effective process to treat alcohol use disorder involved therapists confronting their clients about their behavior. However, Connors' work over several years, along with other emerging research, has shown a more positive relationship between therapist and client yields better results.

"Many recent studies have recognized that a positive therapeutic alliance between a therapist and client is necessary for achieving behavior change, but much less has been known about how alliances operate across a full course of treatment," Connors says.

Risk of Dropping Out of Treatment

"By studying the alliance on a session-to-session basis, we could see how a fractured alliance at a given point in time interferes with the pursuit of treatment goals by running the risk of a client dropping out of treatment," he says. "Therefore, it's important for the therapist to continue assessing the alliance throughout the entire course of treatment."

The study also showed a positive alliance was even more critical for patients who had not made changes in their drinking prior to starting treatment. "In contrast, patients who had already reduced their drinking prior to entering treatment were not as dependent on the therapeutic alliance to continue the process of behavior change," Connors says.

Posted by Webmaster at 03:15 AM


Binge Drinking Quickly Leads to Liver Disease

Alcohol consumed during just seven weeks of intermittent binge drinking harms the liver in ways that more moderate daily drinking does not, according to researchers at UC San Francisco. The scientists discovered that just 21 binge drinking sessions were enough to cause symptoms of early-stage liver disease.

Binge drinking produced fatty liver tissue and triggered early stages of inflammation, both indicators of alcohol-induced liver disease. Binging also increased the levels of alcohol-metabolizing enzymes, whose activity can produce oxidative damage and other forms of harm to the liver. Their work appears in the January 19, 2017 "EarlyView" online edition of the journal Alcoholism: Clinical and Experimental Research.

Binge Drinking as Dangerous as Long-Term Drinking

"We sometimes think of alcoholic liver damage as occurring after years of heavy drinking. However, we found that even a short period of what in humans would be considered excessive drinking resulted in liver dysfunction," said Frederic "Woody" Hopf, PhD, the study's senior researcher, an associate adjunct professor of neurology at UCSF, and a member of UCSF's Alcohol Center for Genes and Translation (ACGT). "It is important to intervene early to counter the dangers associated with binge drinking habits," said Hopf, also a member of UCSF's Wheeler Center for the Neurobiology of Addiction.

For a man, binge drinking is defined as consumption of five or more drinks within two hours, an amount equivalent to five bottles of beer, a bottle of wine, or five shots of hard liquor. For a woman, binge drinking involves consumption of four or more drinks in two hours.

88,000 Preventable Deaths Yearly

Reducing binge drinking is particularly important because many binge drinkers go on to develop an alcohol use disorder and associated health risks. Excessive alcohol use, which includes binge drinking, results in about 88,000 preventable deaths yearly in the United States and about 2.5 million years of lost life, according to the U.S. Centers for Disease Control and Prevention (CDC). Most people with an alcohol use disorder develop fatty liver, and of those, about one in five goes on to develop liver cirrhosis, which often is fatal.

In the UCSF study, liver triglycerides were almost 50 percent higher in binge drinkers' livers compared to mice that abstained from alcohol, and triglyceride levels in the blood were almost 75 percent higher. Fat droplets were clearly visible in liver slices from binge drinkers. In contrast, moderate-drinking mice and mice that completed just one binge drinking session did not have significantly elevated triglyceride levels compared to abstainers. "Our results strongly suggest that repeated, excessive alcohol drinking, even without alcohol dependence, can cause fatty liver, evidence of early alcohol-related liver dysfunction," Hopf said.

Binge Drinking Increases Enzyme Levels

The researchers also found that even a single episode of binge drinking elevated the levels of the liver enzyme CYP2E1, which metabolizes alcohol into toxic by-products that can cause oxidative damage and other forms of tissue injury. After seven weeks of binging, there was even more CYPE1 produced in response to binge drinking. Alcohol dehydrogenase, the major alcohol-metabolizing enzyme, was also more abundant in binge-drinking mice. These results suggest that repeated binging increases the levels of these enzymes, which could lead to greater cellular damage.

Repeated binge drinking also increased activation of a gene that immune cells use to make an inflammatory cytokine protein called IL-1B, which is implicated in the liver inflammation seen in alcohol-induced liver disease. The scientists did not detect other alterations in the inflammatory system that are known to accompany later stages of liver cell damage.

Can Damage Be Undone?

"It's not yet clear whether the changes to the liver associated with binge drinking are completely reversible. It could even be that these changes sensitize and prime the liver, so that a subsequent return to binge drinking after long abstinence will more easily cause harm," Hopf said. "Those are experiments we are planning to do next."

For several decades, alcohol researchers have regarded mice as a validated model for learning about mechanisms that drive excessive drinking in humans, according to Hopf. In the newly published study, binge-drinking mice could drink 20 percent alcohol on just three nights per week. "On Monday, Wednesday and Friday nights, they got to drink all they wanted," Hopf said.

On the Road to Liver Damage

On the other hand, mice that had continuous access to alcohol drank more moderately, about half as much as binge drinkers. Alcohol binging in mice produces blood alcohol levels that are comparable to human binge drinking, Hopf said.

UCSF researchers at the ACGT are particularly interested in investigating whether changes in the brains of alcohol-binging mice might shed light on human binge drinking, especially the compulsive drives for alcohol associated with binge drinking that continues despite damaging consequences. The present studies suggest that even more limited alcohol binging is already sufficient to start one on the road to liver damage, Hopf said.

Posted by Webmaster at 03:10 AM


119,000 Children With FAS Born Each Year

Worldwide, an estimated 119,000 children are born with Fetal Alcohol Syndrome (FAS) each year, a new study from the Centre for Addiction and Mental Health (CAMH) shows. The study, published in The Lancet Global Health, provides the first-ever estimates of the proportion of women who drink during pregnancy, as well as estimates of FAS by country, World Health Organization (WHO) region and worldwide.

Globally, nearly 10 per cent of women drink alcohol during pregnancy, with wide variations by country and WHO region. In some countries, more than 45 per cent of women consume alcohol during pregnancy. In Canada, which has clinical guidelines advising abstinence during pregnancy, an estimated 10 per cent of pregnant women still drink, which is close to the estimated world average.

Prevalence of FAS Increasing

Nearly 15 per 10,000 people around the world are estimated to have FAS, the most severe form of Fetal Alcohol Spectrum Disorder (FASD). FAS is characterized by mental, behavioural and learning problems, as well as physical disabilities. In Canada, the estimate is 10.5 cases of FAS per 10,000 people.

Not every woman who drinks while pregnant will have a child with FAS. "We estimated that one in 67 mothers who drink during pregnancy will deliver a child with FAS," says lead author Dr. Svetlana Popova, Senior Scientist in CAMH's Institute for Mental Health Policy Research.

She notes that this figure is very conservative and does not include other types of FASD that may occur from alcohol consumption during pregnancy, including partial FAS (pFAS) and Alcohol-related Neurodevelopmental Disorders (ARND).

Safest to Completely Abstain

Although it's well established that alcohol can damage any organ or system in the developing fetus, particularly the brain, it's still not known exactly what makes a fetus most susceptible, in terms of the amount or frequency of alcohol use, or timing of drinking during pregnancy. Other factors, such as the genetics, stress, smoking and nutrition also contribute to the risk of developing FASD.

"The safest thing to do is to completely abstain from alcohol during the entire pregnancy," says Dr. Popova.

The study involved comprehensive literature reviews and statistical analyses to determine the estimates, which are intended to help countries plan public health initiatives and policies, such as FAS surveillance systems and educational efforts on the risks of alcohol use during pregnancy, the researchers note.

Rates Highest in Europe

The five countries with the highest alcohol use in pregnancy were in Europe: Russia, United Kingdom, Denmark, Belarus and Ireland. As a region, Europe also had a 2.6 higher prevalence of FAS than the global average. The lowest levels of drinking and FAS were found for the Eastern Mediterranean and South East Asia regions, as there are high rates of alcohol abstinence in these regions.

The predictive model that the research team developed in this study could also be used to estimate the prevalence of other disease conditions, notes Dr. Popova. Her team is currently extending this work to study the global scale of all fetal alcohol spectrum disorders (FASD). An earlier study by Dr. Popova and her team, published in The Lancet last year, showed that more than 400 disease conditions co-occur with FASD.

Posted by Webmaster at 03:08 AM


Ignition Interlock Devices Reduce Fatal Crashes

State laws requiring ignition interlocks for all drunk driving offenders appear to reduce the number of fatal drunk driving crashes, a new study by Johns Hopkins Bloomberg School of Public Health and Colorado School of Public Health researchers suggests.

The study -- published in the American Journal of Preventive Medicine -- found that mandatory interlock laws were associated with a seven percent decrease in the rate of fatal crashes with at least one driver with a blood alcohol content over the legal limit. The decrease translates into an estimated 1,250 prevented fatal crashes in states with mandatory interlock laws since states first started passing such laws in 1993.

An ignition interlock is an alcohol-sensing device, connected to the ignition of a vehicle, which detects alcohol in the driver's breath. If alcohol in excess of a preset limit is detected by the sensor, the vehicle will not start. While all 50 states have some type of ignition interlock laws, 26 have mandatory laws requiring all individuals convicted of a DUI offense to use an interlock in order to drive legally, as of March 2016.

Mandatory Interlocks for All Are Most Effective

This is the first study to look at all the different types of interlock laws across all 50 states. The researchers found that interlock laws which are mandatory for all DUI offenders were much more effective than those applicable to only some offenders, such as only repeat offenders or those with a very high blood alcohol content.

In the United States in 2014, alcohol-involved fatal motor vehicle crashes caused approximately 10,000 deaths, about one-third of all motor vehicle crash deaths.

Interlock Laws Save Lives

"Our study demonstrates the value of mandatory ignition interlock laws across the United States," says study leader Emma E. "Beth" McGinty, PhD, MS, deputy director at the Johns Hopkins Center for Mental Health and Addiction Policy Research at the Bloomberg School. "We already know that alcohol plays a tragic role in the number of motor vehicle crash fatalities each year. Interlock laws which are mandatory for all DUI offenders save lives. "

To estimate the effects of existing ignition interlock laws, the researchers studied the effects of interlock laws on trends in alcohol-involved fatal crashes over a 32-year period, 1982 to 2013, and controlled for other motor vehicle safety laws and trends in crashes over time. The team assessed changes in pre- and post-interlock law rates of alcohol-involved fatal crashes with crash data obtained from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS), and measured them against the different categories of interlock laws: permissive (at the discretion of a judge), partial (applicable to only some DUI offenders), and mandatory for all.

More States Adopting Interlock Laws

The researchers used two measures based on FARS data: alcohol-involved fatal crashes with a driver having a blood alcohol level of 0.08--the legal limit--and a second data set with a driver with a blood alcohol level greater than 0.15.

"Until recently, there hasn't been any evidence on whether these laws prevent alcohol-involved fatal crashes, and specifically whether mandatory/all laws are more effective than permissive and partial laws," McGinty says. "Our study suggests that they are effective, and it's encouraging to see more and more states moving towards this evidence-based policy change. Since 2005, we've seen over 20 states adopt interlock laws for all drunk-driving offenses. We'd like to see the remaining states follow suit."

Posted by Webmaster at 03:06 AM


Alcohol Increases Risks of Heart Conditions

Alcohol abuse increases the risk of atrial fibrillation, heart attack and congestive heart failure as much as other well-established risk factors such as high blood pressure, diabetes, smoking and obesity, according to a study published in the Journal of the American College of Cardiology.

Despite advances in prevention and treatments, heart disease is the No. 1 killer of men and women in the US. Reducing alcohol abuse might result in meaningful reductions of heart disease, according to the researchers.

"We found that even if you have no underlying risk factors, abuse of alcohol still increases the risk of these heart conditions," said lead researcher Gregory M. Marcus, MD, director of clinical research in the Division of Cardiology at the University of California, San Francisco.

Double the Risk of Atrial Fibrillation

The researchers analyzed data from a database of all California residents ages 21 and older who received ambulatory surgery, emergency or inpatient medical care in California between 2005 and 2009. Among the 14.7 million patients in the database, 1.8 percent, or approximately 268,000, had been diagnosed with alcohol abuse.

The researchers found that after taking into account other risk factors, alcohol abuse was associated with a twofold increased risk of atrial fibrillation, a 1.4-fold increased risk of heart attack and a 2.3-fold increased risk of congestive heart failure. These increased risks were similar in magnitude to other well-recognized modifiable risk factors such as diabetes, high blood pressure and obesity.

Completely eradicating alcohol abuse would result in over 73,000 fewer atrial fibrillation cases, 34,000 fewer heart attacks, and 91,000 fewer patients with congestive heart failure in the United States alone, the researchers said.

Drinking Not Good for the Heart

"We were somewhat surprised to find those diagnosed with some form of alcohol abuse were at significantly higher risk of a heart attack," Marcus said. "We hope this data will temper the enthusiasm for drinking in excess and will avoid any justification for excessive drinking because people think it will be good for their heart. These data pretty clearly prove the opposite."

Previous research has suggested that moderate levels of alcohol consumption may help prevent heart attack and congestive heart failure, while even low to moderate levels of alcohol consumption have been shown to increase the incidence of atrial fibrillation.

Documented Alcohol Abuse

"The great majority of previous research relied exclusively on self-reports of alcohol abuse," Marcus said. "That can be an unreliable measure, especially in those who drink heavily. In our study, alcohol abuse was documented in patients' medical records." He said that the study did not quantify how much alcohol patients drank.

In an editorial accompanying the new study, Michael H. Criqui, MD, MPH, of the University of California San Diego, wrote that previous studies that found a benefit from alcohol consumption in protecting against heart attack and congestive heart failure were so-called cohort studies, which include defined populations. Such studies tend to recruit stable, cooperative and health-conscious participants who are more likely to be oriented toward a heathier lifestyle.

"Cohort studies have minimal participation by true alcohol abusers, so the current study likely presents a more valid picture of heavy drinking outcomes," Criqui said.

Posted by Webmaster at 03:04 AM


Primary Care Should Include Drug Screening

The misuse of both prescription and illicit drugs is so prevalent in Tijuana and East Los Angeles that community clinics in those areas should routinely, though discreetly, screen for it, according to new UCLA research. The study, published in the peer-reviewed journal Substance Use and Misuse, found that 19.4 percent of people answering a computerized self-administered survey in East Los Angeles community clinics admitted to moderate-to-high drug use.

In Tijuana it was 5.7 percent. Rates of drug use among the participants in the study were much higher than what has been found in household surveys in the two countries.

The researchers also found that Los Angeles patients born in Mexico were twice as likely, and Los Angeles patients born in the United States were six times more likely, of being moderate-to-high drug users compared with Tijuana patients born in Mexico.

High Rate of Drug Use Was Surprising

The findings of high rates of drug use ran counter to assumptions, said Dr. Lillian Gelberg, the study's lead investigator and a professor of family medicine at the David Geffen School of Medicine at UCLA.

"Prevailing expectations were that alcohol would be the major problem and drug use would be lower,'' said Gelberg, who is also a professor of health policy and management at the UCLA Fielding School of Public Health. "But what we found was that the rate of problem drug use -- that is, moderate-to-high use -- was very similar to problem alcohol use."

Moderate-to-high alcohol use was 15.2 percent in East Los Angeles compared to 6.5 percent in Tijuana. Moderate-to high tobacco use was 20.4 percent in East Los Angeles and 16.2 percent in Tijuana.

Drug Screening Should Be Routine

While drug use was higher in Los Angeles than it was in Tijuana, the rates in both cities are high enough that screening for drug, alcohol and tobacco use should be integrated into routine primary care in community clinics on both sides of the border, said Melvin Rico, clinical research coordinator in the UCLA Department of Family Medicine who served as the field research coordinator for the study.

"Being able to reach a vulnerable population while waiting for a doctor is, I think, very important," Rico said.

The paper is part of a larger study of an intervention that found a few minutes of counseling in a primary care setting could steer people away from risky drug use and full-fledged addiction.

Self-Reported Substance Abuse

For this study, which ran from March 2013 through October 2013, the researchers recruited 2,507 adults in Los Angeles and 2,890 in Tijuana who were eligible for the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test. The researchers designed a simple tool that allowed participants to anonymously self-report substance abuse on a computer tablet with a touch screen. Given the stigma associated with drug use, the researchers wanted to remain sensitive to people's fears of privacy in a way that still encouraged them to be truthful about their substance use.

Questions about substance use were combined with others about healthy eating, exercise, and chronic illnesses so that the patients would not feel stigmatized about a particular behavior, Gelberg said.

Quiz Adapted for Cultural Differences

"We aren't using interviews and the patients are filling it in on their own," she said. "We developed this program so that it would work even for patients of low-literacy levels, asking one question at a time and allowing for an audio option with headsets according to patient's preference. For instance, it would ask 'did you use cocaine in the last three months and a 'yes' or 'no' would light up on the computer screen.'"

The tool could also easily switch between English and Spanish and the questions and approach were adapted to Latinos in Mexico, whose culture and characteristics had differences compared to those in Los Angeles.

Results Subject to Under-Reporting

Participants took the survey while they were in the clinic waiting room, and it took very little time -- a mean of 1.3 minutes in Tijuana and 4.2 minutes in Los Angeles.

This tool can be of use in a primary care clinic because people generally don't volunteer their drug use to their doctors, who for their part don't know how to broach the subject, Gelberg said.

The study has some limitations. Substance use was based on patient self-reporting, which could make the findings subject to under-reporting. Also, the findings may or may not be the same in health care settings other than community health centers or in other cities in the United States and Mexico.

Posted by Webmaster at 03:01 AM


Alcohol Risks Increasing for Older Adults

Alcohol is the most commonly used psychoactive substance among older adults, and this group can have unique risks associated with alcohol consumption -- in even lower amounts -- compared to younger persons.

"Older adults have particular vulnerabilities to alcohol due to physiological changes during aging, including increasing chronic disease burden and medication use," said Benjamin Han, MD, MPH, a geriatrician and health services researcher at the Center for Drug Use and HIV Research (CDUHR) and in the Division of Geriatric Medicine and Palliative Care at NYU Langone Medical Center (NYU Langone). "However, no recent studies have estimated trends in alcohol use, including binge alcohol use and alcohol use disorders among older adults."

Significant Increases in Alcohol Use, Binge Drinking

To address the lack of research, Dr. Han and his team examined data from the National Survey on Drug Use and Health (years 2005 to 2014) in a paper published in the journal Drug and Alcohol Dependence. Trends of self-reported past-month binge alcohol use and alcohol use disorder were examined among adults age 50 and older.

The researchers found significant increases in past-year alcohol use, past-month alcohol use, past-month binge drinking, and alcohol use disorders. The paper, "Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005-2014." Published on-line 12 December 2016.

Binge Drinking Increased for Women

Results also suggest that while men had a higher prevalence of binge alcohol use and alcohol use disorders than women, binge alcohol use and alcohol use disorder increased among women in this nationally representative sample.

"As females age, they tend to experience a larger impact of physiological changes in lean body mass compared to men," commented Dr. Han. "Thus, they may experience the adverse effects associated with consuming alcohol even in lower amounts."

Risking Sexual Situations a Factor

"The increase in binge drinking among older women is particularly alarming" said Dr. Palamar, PhD, MPH, a CDUHR affiliated researcher and an assistant professor of Population Health at NYU Langone. "Both men and women are at risk for getting themselves into risky sexual situations while drinking, but women are at particularly high risk." Dr. Palamar also stated that "heavy drinking can not only have unintended health consequences, but it can also lead to socially embarrassing or regretful behavior."

For the researchers, the results also raise public health concerns, given the significant increases in binge alcohol use among older adults who reported "fair/poor" health and/or multiple chronic conditions. This population is particularly vulnerable to the negative effects of alcohol as it can impact chronic disease management or increase the risk of injury.

"Health care providers need to be made aware of this increasing trend of unhealthy alcohol use, particularly among older females, and ensure that screening for unhealthy alcohol use is part of regular medical care for this population" said Dr. Han.

Posted by Webmaster at 03:00 AM


August 13, 2017

Is Kratom an Opioid Alternative?

A delayed U.S. Drug Enforcement Administration ban on kratom would stifle scientific understanding of the herb's active chemical components and documented pharmacologic properties if implemented, according to a special report published today in The Journal of the American Osteopathic Association.

The report cited the pharmacologically active compounds in kratom, including mitragynine, 7-hydroxymitragynine, paynantheine, speciogynine and 20 other substances, as one basis for further study. It also emphasized the extensive amount of anecdotal evidence and current scientific research that indicates kratom may be safer and less addictive than current treatments for pain and opioid withdrawal.

Kratom Does Not Depress Respiration

"There's no question kratom compounds have complex and potential useful pharmacologic activities and they produce chemically different actions from opioids," said author Walter Prozialeck, chairman of the Department of Pharmacology at Midwestern University Chicago College of Osteopathic Medicine. "Kratom doesn't produce an intense euphoria and, even at very high doses, it doesn't depress respiration, which could make it safer for users."

Kratom (Mitragyna speciosa) is indigenous to Southeast Asia, where the plant was used for centuries to relieve fatigue, pain, cough and diarrhea and aid in opioid withdrawal. Currently sold in the United States as an herbal supplement, kratom drew DEA scrutiny after poison control centers noted 660 reports of adverse reactions to kratom products between January 2010 and December 2015.

Source of Adverse Reactions Unclear

"Many important medications, including the breast cancer treatment tamoxifen, were developed from plant research," said Prozialeck.

"While the DEA and physicians have valid safety concerns, it is not at all clear that kratom is the culprit behind the adverse effects," said Anita Gupta, DO, PharmD and special advisor to the FDA.

A Non-Pharmaceutical Remedy?

Dr. Gupta, an osteopathic anesthesiologist, pain specialist and licensed pharmacist, has treated a number of patients who've used kratom. "Many of my patients are seeking non-pharmaceutical remedies to treat pain that lack the side effects, risk, and addiction potential of opioids," she said.

Kratom is currently banned in states including Alabama, Florida, Indiana, Arkansas, Wisconsin and Tennessee. The DEA is scheduled to decide whether to place kratom on its list of Schedule 1 drugs, a classification for compounds thought to have no known medical benefit. Marijuana, LSD and heroin are Schedule 1 drugs, which prevents the vast majority of U.S.-based researchers from studying those substances.

Posted by Webmaster at 08:15 PM


Moms' Sensitivity a Key to Prevention

Research from the University at Buffalo Research Institute on Addictions suggests the approach to preventing alcohol and drug use by some adolescents should begin in early childhood.

"The children of parents with alcohol problems are at much greater risk for underage drinking and developing a substance use disorder," says the study's author, Rina Das Eiden, PhD, senior research scientist at RIA. "It's important to understand when and under what circumstances such problems develop, so we can craft interventions to steer this high-risk population away from substance use and its attendant problems."

Pathway Begins Early for Children of Alcoholics

Eiden examined different pathways to adolescent substance use, starting in infancy, for children of parents with alcohol use disorder (AUD), and found that maternal warmth and sensitivity in early childhood played a significant role.

"When mothers can be warm and sensitive during interactions with their toddlers, even under the stresses associated with their partners' alcohol problems, there is a lower likelihood of adolescent substance use," Eiden says.

Drinking Parents Less Sensitive

Parents with AUD demonstrated lower rates of maternal sensitivity toward their toddlers, continuing into kindergarten age, Eiden found. As the children entered middle school (6th grade), their mothers were less likely to monitor peer groups and activities, leading to higher engagement with substance-using and delinquent peers and drinking in early adolescence (8th grade).

These children also displayed lower self-regulation, or the ability to behave according to rules without supervision, at preschool age, leading to problem behaviors from kindergarten age to early adolescence and higher alcohol and marijuana use in late adolescence.

Encouraging Mothers to Be Sensitive

The results have implications for both the timing and content of preventive interventions against substance use among adolescents of parents with AUD. Timing interventions in early childhood and before major developmental transitions, such as transition to school and moving from elementary to middle school, may be most beneficial.

For content, the most helpful interventions would be to encourage and support mothers in being warm and sensitive during interactions with their toddlers, and to keep a close eye their children's activities and peer groups during the transition from middle childhood to early adolescence.

"This attention also would promote children's self-regulation in the preschool years, which may lead to a decrease in problem behaviors from school age into adolescence," Eiden says.

The article appears in the October issue of Developmental Psychology.

Posted by Webmaster at 08:14 PM


Video Games Influence Teens to Drink, Smoke

Images and references to alcohol and tobacco in popular video games may be influencing teens who play the games and the age restriction system is not working, according to a new study.

Experts from the UK Centre for Tobacco and Alcohol Studies at The University of Nottingham have carried out the first ever analysis of best-selling video games to find out the extent to which the games include this content and to assess the link between playing the games and drinking and smoking behaviour.

Twice as Likely to Smoke, Drink Alcohol

They found that teenagers who play video games featuring alcohol and tobacco references appeared to be directly influenced because they were twice as likely to have tried smoking or drinking themselves.

The research examined the content of 32 UK best-selling video games of 2012/2013 and carried out a large online survey of adolescents playing games with alcohol and tobacco content. An analysis of 'cut scenes' uploaded by gamers to YouTube from the five most popular games was also carried out. All the games studied were from the genres of stealth, action adventure, open world, shooter and survival/horror because they involve avatars that look and act like real people.

44% of Video Games Contain Alcohol, Tobacco

The study, published in the journal Cyberpsychology, Behavior and Social Networking, found alcohol and tobacco content in 44% of the most popular video games. They also found this content was not reported by the official regulator, the Pan-European Games Information (PEGI) system which informs the Video Standards Council age ratings that help parents decide whether game content is suitable for their children.

The researchers used YouGov survey tools to ask 1,094 UK adolescents aged 11-17 whether they had played any of the most popular video games identified as containing either tobacco or alcohol imagery. They were also asked whether and to what extent they smoked or drank alcohol. The study found that adolescents who had played at least one game with tobacco or alcohol content were twice as likely to have tried smoking or consumed alcohol themselves.

Grand Theft Auto, Black Ops

Out of the top five most popular games, Grand Theft Auto V & VI contained the highest level of alcohol and smoking content using fictitious brands only. The other top games containing these references were Call of Duty:Black Ops II, Call of Duty:Modern Warfare 3 and Assassin's Creed III. There was no electronic cigarette content.

Psychologist Dr Joanne Cranwell from the UK Centre for Tobacco and Alcohol Studies, said "Although around 54% of UK adolescents play video games online, parental concern over exposure to inappropriate content while playing video games seems to be lower than for other media, like movies for example. While 80% of children aged 10-15 play packaged or online video games with an age rating higher than their age, more than half of British parents are unaware of the harmful content this exposes them to.

Descriptors Are Not Working

"Video games are clearly attractive to adolescents regardless of age classification. It appears that official PEGI content descriptors are failing to restrict youth access to age inappropriate content. We think that the PEGI system needs to include both alcohol and tobacco in their content descriptors. Also, game developers could be offered incentives to reduce the amount of smoking and drinking in their games or to at least reference smoking and drinking on their packaging and websites.

"As a child protection method it is naïve for both the games industry and the Interactive Software Federation of Europe, who regulate the PEGI system, to rely on age ratings alone. Future research should focus on identifying the levels of exposure in terms of dose that youth gamers are exposed to during actual gameplay and the effects of this on long- term alcohol and smoking behaviour."

Posted by Webmaster at 08:08 PM


Drug-Use Can Hamper Moral Judgment

Regular cocaine and methamphetamine users can have difficulty choosing between right and wrong, perhaps because the specific parts of their brains used for moral processing and evaluating emotions are damaged by their prolonged drug habits. This is according to a study among prison inmates by Samantha Fede and Dr. Kent Kiehl's laboratory at the University of New Mexico and the nonprofit Mind Research Network. The findings of the study, which was funded by the National Institute on Drug Abuse, are published in Springer's journal Psychopharmacology.

Research has shown that stimulant users often find it difficult to identify other people's emotions, particularly fear, and to show empathy. These aspects play an important role in moral decision making. Other studies have pointed to structural and functional abnormalities in especially the frontal regions of their brains among stimulant users. These areas are engaged when moral judgments have to be made.

Drug Use and Criminal Behavior

There is strong link between drug use and criminal behavior, and up to 75 percent of inmates in the US have substance abuse problems. It is not known whether the criminal behavior is in part a result of the drugs' effects on brain function.

Kiehl's team is the first to examine how the neural networks and brain functioning of chronic cocaine and methamphetamine users in US jails relate to their ability to evaluate and decide about moral situations or scenarios. Poor judgment about moral situations can lead to poor decision making and subsequent antisocial behavior.

Chemical Changes in the Brain

The researchers recorded the life history of substance abuse of 131 cocaine and methamphetamine users and 80 non-users incarcerated in New Mexico and Wisconsin prisons. The participants' brains were scanned while they completed a moral decision-making task in which they evaluated whether certain phrases were morally wrong or not.

Compared to the non-users, the regular stimulant users had abnormal neural activity in the frontal lobes and limbic regions of their brains during moral processing. Specifically, lifetime stimulant users showed less activity in the amygdala, a group of neurons in the brain that helps to regulate and understand emotions. The researchers also observed a relationship in the level of engagement of the anterior cingulate cortex: the longer people had been using stimulants, the less activity in this region. This is an area of the brain that coordinates reinforcement, effect and executive action needed in moral decision making.

Impaired Decision-Making

"This is the first study to suggest impairments in the neural systems of moral processing in both cocaine and methamphetamine users," says lead author Fede. "Although further research into the connectivity of systems in stimulant use is needed, this provides promising initial understanding of fronto-limbic deficits in stimulant users."

The research team acknowledges that people who are prone to regular stimulant use might already struggle with moral processing even before they begin to use drugs such as cocaine. The effects found related to use over time in the anterior cingulate cortex and the ventromedial prefrontal cortex, another region implicated in moral decision making, however, indicate that methamphetamine and cocaine may have a serious impact on the brain.

Posted by Webmaster at 08:06 PM


How Is Weed Linked to Drinking?

Adults who use marijuana are five times more likely to develop an alcohol use disorder (AUD) -- alcohol abuse or dependence -- compared with adults who do not use the drug. And adults who already have an alcohol use disorder and use marijuana are more likely to see the problem persist.

Results of a study by researchers at Columbia University's Mailman School of Public Health and the City University of New York appear online in the journal Drug and Alcohol Dependence.

Increased Risk of Alcohol Problems

"Our results suggest that cannabis use appears to be associated with an increased vulnerability to developing an alcohol use disorder, even among those without any history of this," said Renee Goodwin, PhD, associate professor of Epidemiology at the Mailman School of Public Health. "Marijuana use also appears to increase the likelihood that an existing alcohol use disorder will continue over time."

The researchers analyzed data from 27,461 adults enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions who first used marijuana at a time when they had no lifetime history of alcohol use disorders.

The population was assessed at two time points. Adults who had used marijuana at the first assessment and again over the following three years (23 percent) were five times more likely to develop an alcohol use problem, compared with those who had not used marijuana (5 percent).

Marijuana Smokers Delay Alcohol Treatment

Adult problem drinkers who did not use cannabis were significantly more likely to be in recovery from alcohol use disorders three years later.

"From a public health standpoint we recommend that further research be conducted to understand the pathways underlying these relationships as well as the degree to which various potentially vulnerable population subgroups -- youth, for example -- are at increased risk," noted Goodwin. "If future research confirms these findings, investigating whether preventing or delaying first use of marijuana might reduce the risk of developing alcohol use disorders among some segments of the population may be worthwhile."

Posted by Webmaster at 08:03 PM


Early Binge Drinking Linked to Hypertension

Having an occasional drink is fine, but "binge" drinking is a known health hazard and now high blood pressure may need to be added to the list of possible consequences. Young adults in their twenties who regularly binge drink have higher blood pressure which may increase the risk of developing hypertension, concludes a study conducted by researchers at the University of Montreal Hospital Research Centre (CRCHUM).

Binge drinking (i.e. consuming five or more alcoholic beverages in less than two hours), is quite prevalent: previous studies in Canada and the U.S. have shown that about four in ten young adults aged 18 to 24 are frequent binge drinkers.

Binge Drinking Affects Blood Pressure

Now researchers have demonstrated, for the first time, that binge drinking may have an effect on blood pressure, which can increase the risk of developing hypertension and chronic diseases related to hypertension.

"We found that the blood pressure of young adults aged 20 to 24 who binge drink was 2 to 4 millimetres of mercury higher than non-binge drinkers," says Jennifer O'Loughlin, senior author of a study published today in the Journal of Adolescent Health.

Data on alcohol consumption at age 20 were collected from 756 participants in the Nicotine Dependence in Teens study, which has followed 1294 young people from diverse social backgrounds in Montreal, Canada since 1999. Data were collected again at age 24, at which time participants' systolic blood pressure was also taken.

One in Four Affected, Study Shows

Systolic blood pressure measures the pressure in the arteries when the heart beats (i.e., when the heart muscle contracts), and it should be below 140 millimetres of mercury. A blood pressure reading of more than 140 over 90 indicates high blood pressure. The latter number, diastolic blood pressure, measures the pressure in the arteries between heartbeats (i.e., when the heart muscle is resting between beats and refilling with blood).

"Our findings show that more than one in four young adults who binge drink meet the criterion for pre-hypertension (i.e., a systolic blood pressure between 120 and 139 millimetres of mercury). This is worrisome because this condition can progress to hypertension, which in turn can cause heart disease and premature death," says O'Loughlin, a researcher at the CRCHUM and professor in the School of Public Health, University of Montreal.

Risk of Chronic Diseases

Health professionals and others may need to adopt a preventive approach, recommends O'Loughlin: "Poor diet, salt intake, and obesity are predictors of high blood pressure.

Since we know there is a link between higher blood pressure and the risk of developing chronic diseases, clinicians should ask young people about their alcohol consumption. A slight and continuous increase in systolic blood pressure may be an important warning sign."

The study also revealed that 85% of young adults who drink heavily at age 20 maintain this behaviour at age 24. But unlike our genetic make-up, risky behaviour can be changed.

When to Intervene?

The researchers will now investigate whether this trend toward high blood pressure will continue when binge drinkers turn 30. With work and family obligations, binge drinking may become less frequent. Other questions that arise include: will the short-term effects of binge drinking disappear when binge drinking declines?

Is there a critical time period in which to intervene to prevent hypertension? While awaiting for answers to these questions, the old adage "moderation is always in good taste" may apply.

Posted by Webmaster at 07:58 PM


Alcohol Helps Bacteria Harm the Liver

End-stage liver disease or liver cirrhosis is the tenth leading cause of death in the United States, and approximately half of these cases are related to alcohol consumption. There's no refuting that alcohol itself harms the liver, but new research in mice and humans published February 10 in Cell Host & Microbe reveals that chronic drinking also promotes the growth of gut bacteria that can travel to the liver and exacerbate liver disease.

Gastroenterologist Bernd Schnabl of the University of California, San Diego School of Medicine and his colleagues found that chronic alcohol consumption suppresses the mouse antibacterial defense system in the intestine. It does so by blocking intestinal cells' ability to produce natural antibiotic proteins (called REG3B and REG3G).

Gut Bacteria Reaching the Liver

"Intestinal bacteria can now not only proliferate, but also slowly migrate through the intestinal wall," says Schnabl. "Since the liver encounters all the blood coming from the intestine, not only important nutrients but also bacteria can now reach the liver. The direct damage that is caused by alcohol to the liver is augmented by the arrival of these gut bacteria, through mechanisms that are currently unknown."

The team also found that mice genetically engineered to lack REG3G had more of these bacteria after consuming alcohol, and they developed more severe alcoholic liver disease than their littermates. However, restoring REG3G to the intestine reduced the levels of bacteria that traveled to the liver and protected against alcohol-induced liver damage.

Finally, the researchers found that humans with alcohol dependency had elevated levels of bacteria in their small intestines. The team's previous research showed that they also had lower levels of REG3G.

Probiotic Bacteria Needed

While it may be best for patients at risk of liver disease to stop drinking altogether, Schnabl notes that it can be difficult for some to do so. These latest findings indicate that it may be possible to help patients with alcoholic liver disease by boosting their intestinal defense against certain bacteria, for example by encouraging the growth of good (probiotic) bacteria or by stimulating the production of intestinal antibiotics such as REG3G.

The National Institute on Alcohol Abuse and Alcoholism states that "low-risk" drinking levels for men are no more than 4 drinks on any single day and no more than 14 drinks per week. For women, "low-risk" drinking levels are no more than three drinks on any single day and no more than 7 drinks per week.

Posted by Webmaster at 07:55 PM


Over 400 Conditions Co-Occur With FASD

Researchers at the Centre for Addiction and Mental Health (CAMH) have identified 428 distinct disease conditions that co-occur in people with Fetal Alcohol Spectrum Disorders (FASD), in the most comprehensive review of its kind.

The results were published in The Lancet.

"We've systematically identified numerous disease conditions co-occurring with FASD, which underscores the fact that it isn't safe to drink any amount or type of alcohol at any stage of pregnancy, despite the conflicting messages the public may hear," says Dr. Lana Popova, Senior Scientist in Social and Epidemiological Research at CAMH, and lead author on the paper. "Alcohol can affect any organ or system in the developing fetus."

Severity and Symptoms Vary

FASD is a broad term describing the range of disabilities that can occur in individuals as a result of alcohol exposure before birth. The severity and symptoms vary, based on how much and when alcohol was consumed, as well as other factors in the mother's life such as stress levels, nutrition and environmental influences. The effects are also influenced by genetic factors and the body's ability to break down alcohol, in both the mother and fetus.

Different Canadian surveys suggest that between six and 14 per cent of women drink during pregnancy.

428 Co-Occurring Conditions

The 428 co-occurring conditions were identified from 127 studies included in The Lancetreview. These disease conditions, coded in the International Classification of Disease (ICD-10), affected nearly every system of the body, including the central nervous system (brain), vision, hearing, cardiac, circulation, digestion, and musculoskeletal and respiratory systems, among others.

While some of these disorders are known to be caused by alcohol exposure - such as developmental and cognitive problems, and certain facial anomalies - for others, the association with FASD does not necessarily represent a cause-and-effect link.

Problems range from communications disorders to hearing loss

However, many disorders occurred more often among those with FASD than the general population. Based on 33 studies representing 1,728 individuals with Fetal Alcohol Syndrome (FAS), the most severe form of FASD, the researchers were able to conduct a series of meta-analyses to establish the frequency with which 183 disease conditions occurred.

More than 90 per cent of those with FAS had co-occurring problems with conduct. About eight in 10 had communications disorders, related to either understanding or expressing language. Seven in 10 had developmental/cognitive disorders, and more than half had problems with attention and hyperactivity.

Cause May Be Overlooked

Because most studies were from the U.S., the frequency of certain co-occurring conditions was compared with the general U.S. population. Among people with FAS, the frequency of hearing loss was estimated to be up to 129 times higher than the general U.S. population, and blindness and low vision were 31 and 71 times higher, respectively.

"Some of these other co-occurring problems may lead people to seek professional help," says Dr. Popova. "The issue is that the underlying cause of the problem, alcohol exposure before birth, may be overlooked by the clinician and not addressed."

The benefits of screening and diagnosis

Improving the screening and diagnosis of FASD has numerous benefits. Earlier access to programs or resources may prevent or reduce secondary outcomes that can occur among those with FASD, such as problems with relationships, schooling, employment, mental health and addictions, or with the law.

"We can prevent these issues at many stages," says Dr. Popova. "Eliminating alcohol consumption during pregnancy or reducing it among alcohol-dependent women is extremely important. Newborns should be screened for prenatal alcohol exposure, especially among populations at high risk. And alerting clinicians to these co-occurring conditions should trigger questions about prenatal alcohol exposure."

Stay Away From Alcohol If Pregnant

"It is important that the public receive a consistent and clear message - if you want to have a healthy child, stay away from alcohol when you're planning a pregnancy and throughout your whole pregnancy," she says.

It's estimated that FASD costs $1.8 billion annually in Canada, due largely to productivity losses, corrections and health care costs, among others.

In addition to this review, Dr. Popova has been part of an expert group of leading FASD researchers and clinicians working with the Ontario Ministry of Children and Youth Services on its new FASD strategy. Her team is also undertaking a study to determine how common FASD is in Canada, as well as in other countries in Eastern and Central Europe and Africa.

Posted by Webmaster at 07:52 PM


Marijuana Poses Danger in Early Pregnancy

Marijuana is up to 20 times more potent than it was 40 years ago and most pregnant women who use the drug are unaware that it could harm their unborn child before they even know they are pregnant. Writing in the journal Drug Testing and Analysis, American researcher's state the argument that marijuana is a harmless drug is no longer valid due to the emergence of 'high potency' marijuana and synthetic marijuana which pose a potential real threat for pregnant women.

High Potency Pot

They also express concerns that marijuana's increased popularity among teenagers and young adults could put this group at higher risk.

"The emergence of bioengineered crops and novel, medicinal marijuana strains, means that marijuana is no longer what it used to be in the 1970's and early 1980s': some new, high potency strains, including some medicinal marijuana blends such as 'Connie Chung' and many others, contain up to 20 times more THC, the psychoactive constituent of marijuana, than did 'traditional' marijuana from the 1970's and early 1980's " explains co-author Dr. Delphine Psychoyos from the Center for Genetic and Environmental Medicine at Texas A&M University. "Furthermore, with the emergence of dispensaries and Internet websites, high potency marijuana and Spice products are now readily available to the general population."

Synthetic Cannabinoids

Spice products, a prominent brand of 'synthetic marijuana', or 'fake weed' mixtures, contain extremely potent THC analogues, also called 'synthetic cannabinoids', such as AM694 (found in Euphoric Blends Big Band and others) and HU210 (found in Spice Gold), both of which are 500-600 times more potent than marijuana's THC.

"The THC contained in 'high potency' marijuana and the potent THC analogues contained in Spice products and other brands of 'synthetic marijuana', are potentially harmful to embryonic development, as early as two weeks after conception. This is because these psychoactive chemicals have the ability to interfere with the first stages in the formation of the brain of the fetus; this event occurs two weeks after conception, earlier than before signs of pregnancy appear. By the time a woman realises she is pregnant and stops taking these substances it may already be too late for her unborn child. "

High Rate of Use

"Given that marijuana is the most widely used illicit drug by pregnant women worldwide – one study estimates the rate is as high as 20 per cent - this is a major issue."

Recent research from the past 5 years has shown that marijuana exposure during pregnancy has been associated with anencephaly, a non-sustaining life condition where a large part of the skull or brain is absent, neurobehavioral deficiencies, such as attention deficit hyperactivity disorder, learning disabilities and memory impairment in toddlers and 10 year olds, as well as neuropsychiatric conditions, including depression, aggression and anxiety, in teens.

Increase Awareness Needed

"The problem is that many women who are pregnant, or are planning to become pregnant are totally unaware of this increased potency and the risks they pose," says co-author Dr. Delphine Psychoyos. "This is because many websites on mothering and pregnancy, and those run by pro-marijuana advocacy groups, base their discussions on data collected prior to 1997, when no detrimental affects on pregnancy had been reported; It is important to note here that prior to 1997, pregnant women were mostly exposed to low potency, 'traditional' marijuana, which was the common form of marijuana in the market in the 1970's and early 1980's."

"Marijuana has regained its popularity from the 1970s, especially among teens and young people, and has established social and cultural status as the most popular drug of abuse. Yet, like pregnant women, these young users probably have no idea of the significant increase in potency over the past four decades. "

Be Aware of Health Risks

The researchers are calling for greater awareness among pregnant women about the availability of highly potent marijuana and synthetic cannabinoids such as those found in Spice products, and the risks that they can pose to their unborn child, even before their pregnancy has been confirmed.

They highlight the need to revise U.S. government bills and legislation to take account of the development of synthetic cannabinoids, such as those found in Spice and in new psychoactive substances that are based on cannabinoid research chemicals; They also question whether there is a need to put high potency marijuana in the highest category, if marijuana is to become legalised in America, based on its medical applications.

The authors also stress that teenagers and young people need to be more aware of the health risks of high potency marijuana, of synthetic cannabinoids found in Spice and other brands, and of synthetic cannabinoid research chemicals sold as designer drugs on various non DEA-regulated websites.

Posted by Webmaster at 07:38 PM


Teen Pot Use Leaves Lasting Mental Deficits

The persistent, dependent use of marijuana before age 18 has been shown to cause lasting harm to a person's intelligence, attention and memory, according to an international research team. Among a long-range study cohort of more than 1,000 New Zealanders, individuals who started using cannabis in adolescence and used it for years afterward showed an average decline in IQ of 8 points when their age 13 and age 38 IQ tests were compared.

Quitting pot did not appear to reverse the loss either, said lead researcher Madeline Meier, a post-doctoral researcher at Duke University.

Brain Age a Factor in Marijuana Use

The key variable in this is the age of onset for marijuana use and the brain's development, Meier said. Study subjects who didn't take up pot until they were adults with fully-formed brains did not show similar mental declines. Before age 18, however, the brain is still being organized and remodeled to become more efficient, she said, and may be more vulnerable to damage from drugs.

"Marijuana is not harmless, particularly for adolescents," said Meier, who produced this finding from the long term Dunedin Multidisciplinary Health and Development Study. The study has followed a group of 1,037 children born in 1972-73 in Dunedin, New Zealand from birth to age 38 and is led by Terrie Moffitt and Avshalom Caspi, psychologists who hold dual appointments at Duke and the Institute of Psychiatry at King's College London.

Psychological Tests Given

About 5 percent of the study group were considered marijuana-dependent, or were using more than once a week before age 18. A dependent user is one who keeps using despite significant health, social or family problems.

At age 38, all of the study participants were given a battery of psychological tests to assess memory, processing speed, reasoning and visual processing. The people who used pot persistently as teens scored significantly worse on most of the tests. Friends and relatives routinely interviewed as part of the study were more likely to report that the persistent cannabis users had attention and memory problems such as losing focus and forgetting to do tasks.

The decline in IQ among persistent cannabis users could not be explained by alcohol or other drug use or by having less education, Moffitt said.

8 Points Is Huge

While 8 IQ points may not sound like a lot on a scale where 100 is the mean, a loss from an IQ of 100 to 92 represents a drop from being in the 50th percentile to being in the 29th, Meier said. Higher IQ correlates with higher education and income, better health and a longer life, she said. "Somebody who loses 8 IQ points as an adolescent may be disadvantaged compared to their same-age peers for years to come," Meier said.

Laurence Steinberg, a Temple University psychologist who was not involved in the research, said this study is among the first to distinguish between cognitive problems the person might have had before taking up marijuana, and those that were apparently caused by the drug. This is consistent with what has been found in animal studies, Steinberg added, but it has been difficult to measure in humans.

Early Use Causes Deficits

Animal studies involving nicotine, alcohol and cocaine have shown that chronic exposures before the brain is fully developed can lead to more dependence and long-term changes in the brain. "This study points to adolescence as a time of heightened vulnerability," Steinberg said. "The findings are pretty clear that it is not simply chronic use that causes deficits, but chronic use with adolescent onset."

What isn't possible to know from this study is what a safer age for persistent use might be, or what dosage level causes the damage, Meier said. After many years of decline among US teens, daily marijuana use has been seen to increase slightly in the last few years, she added. Last year, for the first time, US teens were more likely to be smoking pot than tobacco.

"The simple message is that substance use is not healthy for kids," Avshalom Caspi said via email from London. "That's true for tobacco, alcohol, and apparently for cannabis."

Posted by Webmaster at 07:31 PM


Early Alcohol Use Spells Later Trouble

An early age at first drink (AFD) has been linked to later alcohol-related problems, which is one of the reasons behind the legal drinking age of 21 in the U.S. It is unclear, however, if increased risk is primarily due to initiation of any drinking, or initiation of heavier drinking. A comparison of the influence of these potential risk factors among college undergraduates found that both an early AFD as well as a quick progression from the first drink to drinking to intoxication independently predicted later problems.

Results were published in the journal Alcoholism: Clinical & Experimental Research.

Negative Alcohol-Related Outcomes

"Many studies have found relationships between an early AFD and a range of negative alcohol-related outcomes later in life, including the development of alcohol use disorders, legal problems like DUI, and health problems like cirrhosis of the liver," said Meghan Rabbitt Morean, a postdoctoral fellow in the department of psychiatry at Yale University School of Medicine and corresponding author for the study. "There is also evidence that beginning to drink at an early age is associated with more immediate problems, such as compromised brain development and liver damage during adolescence, risky sexual behaviors, poor performance in school, and use of other substances like marijuana and cocaine."

Harriet de Wit, a professor in the department of psychiatry and behavioral neuroscience at The University of Chicago, concurred. "While it is commonly believed that the earlier a person begins drinking alcohol, the more likely it is that he or she will develop problems with drinking, many factors potentially contribute to this relationship, and these factors can only be disentangled with systematic, longitudinal research."

Drinking at an Early Age


While an early AFD is associated with many negative consequences, it is not clear that it directly causes heavy drinking or other negative outcomes, Morean added. "Prior research on early intoxication … suggested to us that making a distinction between the age at which an individual first has any alcohol and the age at which an individual first drinks to intoxication may have important implications for understanding the relative risk associated with starting to drink at an early age," she said.

Morean and her colleagues examined 1,160 freshman (766 females, 394 males) using data gathered from bi-annual assessments from the summer following high-school senior year through the fall of the fourth year of college (four years in total). Participants self-reported their age of drinking onset and age of first self-defined intoxication, as well as frequency of heavy drinking and alcohol-related problems. Analyses looked at the effects of AFD and the time from first use to first intoxication as predictors of heavy drinking and problems across the four years from high school through college.

Greater Risk for Heavy Drinking


"As expected, beginning to use alcohol at an earlier age was associated with heavier drinking and the experience of more negative consequences during senior year of college," said Morean. "Quickly progressing from first alcohol use to drinking to intoxication was also an important predictor of heavy drinking and the experience of alcohol related problems during senior year of college. For example, an adolescent who consumed his first drink at age 15 was at greater risk for heavy drinking and problems than an adolescent who took his first drink at age 17. Further, an adolescent who took his first drink at age 15 and also drank to intoxication at age 15 was at greater risk for heavy drinking and problems than an adolescent who had his first drink at age 15 and did not drink to the point of intoxication until he was 17."

"The authors also found that impulsive personality and family history of alcoholism were related to age of first drink and future problems," added de Wit.

Preventing Alcohol Use


Both Morean and de Wit agreed that early drinking should be delayed, but if it occurs, these youth should be counseled to avoid drinking to intoxication.

"The best way to prevent heavy drinking and the experience of alcohol-related problems is to prevent alcohol use," said Morean. "Therefore, our first recommendation would be to delay the onset of any alcohol use as long as possible. However, despite valiant prevention efforts, the average American adolescent has his or her first alcoholic drink between the ages of 14 and 15 years."

"Furthermore," said de Wit, "it is unlikely that education will discourage high school and college students from drinking at all. However, education may help to make them aware of the potential for developing future problems, and modulate their drinking accordingly."

Speak to Your Children


"It is important to speak to children and adolescents openly about the dangers of heavy drinking and provide them with correct information, for example, 'how many drinks does an average male/female need to drink to exceed the legal level for intoxication?,'" said Morean. "It is also extremely important to remember that heavy drinking during adolescence and early adulthood is not confined to college campuses. Most adolescents begin drinking during high school, a significant portion of whom begin drinking heavily. To help address this, we suggest that new alcohol prevention and intervention efforts targeting high school students be developed with the goal of delaying onset of heavy drinking among those at increased risk due to an early onset of drinking."

Posted by Webmaster at 07:29 PM


Brain Activity Predicts Teen Heavy Drinking

Heavy drinking is known to affect teenagers' developing brains, but certain patterns of brain activity may also help predict which kids are at risk of becoming problem drinkers, according to a study in the Journal of Studies on Alcohol and Drugs.

Using special MRI scans, researchers looked at 40 12- to 16-year-olds who had not started drinking yet, then followed them for about 3 years and scanned them again. Half of the teens started to drink alcohol fairly heavily during this interval.

The investigators found that kids who had initially showed less activation in certain brain areas were at greater risk for becoming heavy drinkers in the next three years.

Drinking Affects Brain Activity

Then once the teens started drinking, their brain activity looked like the heavy drinkers' in the other studies – that is, their brains showed more activity as they tried to perform memory tests. This pattern of heavy drinking typically included episodes of having four or more drinks on an occasion for females and five or more drinks for males.

"That's the opposite of what you'd expect, because their brains should be getting more efficient as they get older," said lead researcher Lindsay M. Squeglia, Ph.D., of the University of California, San Diego.

The findings add to evidence that heavy drinking has consequences for teenagers' developing brains. But they also add a new layer: there may be brain activity patterns that predict which kids are at increased risk for heavy drinking.

"It's interesting because it suggests there might be some pre-existing vulnerability," Squeglia said.

Clues to Problem Drinking

That doesn't mean teenagers are going to start having MRI scans of their brains to see which ones might start drinking. But the findings do give clues into the biological origins of kids' problem drinking.

These findings also reinforce the message that heavy drinking may affect young people's brains right at the time when they need to be working efficiently.

"You're learning to drive, you're getting ready for college. This is a really important time of your life for cognitive development," Squeglia said. She noted that all of the study participants were healthy, well-functioning kids. It's possible that teens with certain disorders -- like depression or ADHD -- might show greater effects from heavy drinking.

Posted by Webmaster at 07:26 PM


Childhood Defiance Linked to Addiction

Children who exhibit oppositional behavior run the risk of becoming addicted to nicotine, cannabis and cocaine while inattention symptoms represent a specific additional risk of nicotine addiction. Nevertheless, hyperactivity in itself does not seem to be associated with any specific risk of substance abuse or dependence.

This is what researchers at the Sainte-Justine University Hospital Center's (UHC) Research Center and the University of Montreal concluded following a 15-year population-based study published in Molecular Psychiatry.

Evaluated by Their Mothers

In order to delineate the roles played by inattention, hyperactivity, opposition, anxiety and adversity, the behavior of 1,803 children between 6 and 12 years of age were evaluated annually by their mothers and teachers. Over half the participants were females. The study revealed that by the age of 21, 13.4% were either abusing or addicted to alcohol, 9.1% to cannabis, and 2.0% to cocaine. Tobacco addiction was a problem for 30.7 % of the participants.

The link between attention deficit hyperactivity disorder (ADHD) in childhood and substance abuse in adulthood was already known. However, very few studies have been undertaken into the particular and respective roles of behavioural symptoms such as opposition that are often concomitant with ADHD (without being part of the disorder), attention deficit and hyperactivity. Furthermore, at least as many girls as boys were sampled in order to assess the potential impact of gender on the findings.

Cannabis and Cocaine Use

"By taking into account the unique effect of inattention and hyperactivity, which had seldom been considered separately before, we came to realize that the link between ADHD symptoms in childhood and substance abuse in adulthood was overestimated and hyperactivity in itself did not seem, in this study, to predispose for future substance abuse," observed Dr. Jean-Baptiste Pingault, a postdoctoral fellow and first author of the study conducted under the supervision of Drs Sylvana Côté and Richard E. Tremblay, both researchers at the Sainte-Justine UHC's Research Center and professors at the University of Montreal.

"We have rather observed strong oppositional behaviors to be associated with cannabis and cocaine abuse. In ADHD symptoms, only inattention is closely correlated with nicotine addiction," he continued. As for the impact of gender on findings, the study reveals opposition and inattention play a largely identical role in girls and boys. However, within the context of the study, it was established that boys consumed more cannabis and alcohol, while girls smoked more cigarettes.

Opposition and Drug Addiction

The strongest behavioral predictor of substance abuse lies in frequent oppositional behavior in childhood, which can be recognized through traits such as irritability, being quick to "fly off the handle," disobedience, refusal to share materials with others to carry out a task, blaming others and being inconsiderate of others. In fact, in strongly oppositional children, the risk of tobacco abuse, once other factors were taken into account, was 1.4 times higher than in children who exhibited little oppositional behavior.

The risk is 2.1 times higher for cannabis abuse and 2.9 times higher for cocaine abuse. It should be noted that the mothers' evaluations provided further essential information in relation to the teachers' evaluations. In fact, some children who were declared highly oppositional by their mothers, but not at all by their teachers, also ran a higher risk of substance abuse and addiction.

Inattention and Smoking

The other important correlation established by the study was the link between inattention and smoking. Very inattentive children had a 1.7-fold increased risk of becoming addicted to tobacco. The degree of inattention even reveals the intensity of future nicotine addiction. The link supported the hypothesis that inattentive people would use tobacco as a "treatment" to help them concentrate.

"If other studies can establish a chemical relation of cause and effect between ADHD symptoms and smoking, we could suppose that treating inattention symptoms would make it easier to quit smoking. Until this is demonstrated, our study's findings nonetheless suggest that the prevention or treatment of inattention and opposition symptoms in children could reduce the risk of smoking and drug abuse in adulthood," concluded Dr. Pingault.

Posted by Webmaster at 07:23 PM


Bariatric Surgery Can Lead to Alcohol Abuse

Among patients who underwent bariatric surgery, there was a higher prevalence of alcohol use disorders in the second year after surgery, and specifically after Roux-en-Y gastric bypass, compared with the years immediately before and following surgery, according to a study in JAMA.

"As the prevalence of severe obesity increases in the United States, it is becoming increasingly common for health care providers and their patients to consider bariatric surgery, which is the most effective and durable treatment for severe obesity. Although bariatric surgery may reduce long-term mortality, and it carries a low risk of short-term serious adverse outcomes, safety concerns remain. Anecdotal reports suggest that bariatric surgery may increase the risk for alcohol use disorders (AUD; i.e., alcohol abuse and dependence)," according to background information in the article.

Higher Alcohol Level Peak

The authors add that there is evidence that some bariatric surgical procedures (i.e., Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy) alter the pharmacokinetics of alcohol. "Given a standardized quantity of alcohol, patients reach a higher peak alcohol level after surgery compared with case-controls or their preoperative levels."

Wendy C. King, Ph.D., of the University of Pittsburgh, and colleagues conducted a study to determine whether the prevalence of AUD changed following bariatric surgery, comparing reported AUD in the year prior to surgery with the first and second years after surgery. The prospective study included 2,458 adults who underwent bariatric surgery at 10 U.S. hospitals. Of these participants, 1,945 (78.8 percent female; 87 percent white; median [midpoint] age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011. The primary outcome measure for the study was past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (AUDIT) (indication of alcohol-related harm, alcohol dependence symptoms, or score 8 or greater).

Increases in 2nd Year

The researchers found that the prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6 percent vs. 7.3 percent), but was significantly higher in the second postoperative year (9.6 percent). Frequency of alcohol consumption and AUD significantly increased in the second postoperative year compared with the year prior to surgery or the first postoperative year.

"More than half (66/106; 62.3 percent) of those reporting AUD at the preoperative assessment continued to have or had recurrent AUD within the first 2 postoperative years," the authors write. "In contrast, 7.9 percent (101/1,283) of participants not reporting AUD at the preoperative assessment had postoperative AUD. Nonetheless, more than half (101/167; 60.5 percent) of postoperative AUD was reported by those not reporting AUD at the preoperative assessment"

The researchers also found that male sex, younger age, smoking, regular alcohol consumption, AUD, recreational drug use, lower score on a measure of a sense of belonging at the preoperative assessment and undergoing a RYGB were independently related to an increased likelihood of AUD after surgery. RYGB accounted for 70 percent of surgeries and doubled the likelihood of postoperative AUD compared with laparoscopic adjustable gastric banding.

Significant Societal Costs

The authors note that although the 2 percent increase (7.6 percent to 9.6 percent) in prevalence of AUD from prior to surgery to the 2-year postoperative assessment may seem small, the increase potentially represents more than 2,000 additional people with AUD in the United States each year, with accompanying personal, financial, and societal costs.

"This study has important implications for the care of patients who undergo bariatric surgery. Regardless of alcohol history, patients should be educated about the potential effects of bariatric surgery, in particular RYGB, to increase the risk of AUD. In addition, alcohol screening and, if indicated, referral should be offered as part of routine preoperative and postoperative clinical care. Further research should examine the long-term effect of bariatric surgery on AUD, and the relationship of AUD to postoperative weight control."

Posted by Webmaster at 07:10 PM


Substance Use Reduces Educational Achievement

Although various kinds of substance use are associated with reduced educational attainment, these associations have been mixed and may also be partially due to risk factors such as socioeconomic disadvantages. A study of substance use and education among male twins from a veteran population has found a strong relationship among early alcohol use, alcohol dependence, daily nicotine use, and fewer years of educational attainment.

Results were published in Alcoholism: Clinical & Experimental Research.

Mixed Results


"Evidence for an association between substance use/abuse/dependence and reduced lifetime educational attainment is mixed," said Julia D. Grant, research assistant professor of psychiatry at Washington University School of Medicine as well as corresponding author for the study.

"In addition," said Matt McGue, a professor in the department of psychology at the University of Minnesota, "what is missing is an explanation for the basis of the association. We might consider two possibilities. One, adolescent substance use results in diminished educational achievement because substance use is neurotoxic to the developing adolescent brain, or because adolescents who use substances have experiences that reduce the likelihood they will pursue higher education."

Another possibility, he added, is that "individuals who use substances in adolescence differ from those who do not on a range of risk factors prior to substance use exposure, which not only lead to their use of substances but also reduce the likelihood they achieve a college education. This possibility means that adolescent substance use is merely an indicator of the risk factors that diminish the likelihood of college attainment."

Lifetime Educational Attainment


"Because our participants were in their late 30s when their educational attainment was assessed, we were better able to address lifetime educational attainment than most previous studies, which have focused on high school dropouts or educational attainment in 18-25 year-olds," said Grant. "We also examined educational attainment in a veteran cohort that had access to education via benefits of the G.I. bill, thereby alleviating some of the economic barriers to higher education that might otherwise be confounded with alcohol and drug outcomes."

Grant and her colleagues examined data collected from two points in time: a 1987 questionnaire, and a 1992 telephone diagnostic interview of 6,242 male twins (n=3,121 pairs with a mean age of 41.9 years in 1992) who had served in the U.S. military during the Vietnam-era and were therefore eligible for educational benefits after military service. Specific factors addressed were reduced educational attainment – defined as less than 16 years – as well as early alcohol and cannabis use, daily nicotine use, lifetime cannabis use, and alcohol, nicotine, cannabis, and any illicit drug dependence.

"Although all substance use measures were associated with lower educational attainment in preliminary analyses," said Grant, "only early alcohol use, alcohol dependence, and daily nicotine use remained significantly associated with reduced educational attainment in twin pairs discordant for substance use. In contrast, the associations between cannabis/other illicit drugs and educational attainment were not significant, suggesting that this association may be attributable to familial influences shared by the two measures."

Sober Twin More Likely to Finish College


"In this study, they conclude that within twin pairs discordant for adolescent substance use, the unexposed twin was more likely to complete college than his/her exposed cotwin," said McGue. "This provides much stronger support for a causal influence than a standard epidemiological study because of the control afforded by comparing the discordant twins. However, it is important to recognize that it does not prove causality."

"It is possible that early alcohol use and alcohol dependence impede later educational attainment," noted Grant. "Possible mechanisms for this include cognitive and motivational changes stemming from early alcohol use/dependence that hinder academic success. Although daily nicotine use is not likely to impair cognitive functioning, it may lead to motivational changes that affect academic performance. It is also possible that the association between these substances and lower educational attainment remains because both are attributable to a factor that we did not control for in our present analyses, such as personality characteristics and cognitive ability prior to substance use."

Complicated Relationship


Grant said these findings underscore the complicated relationship between substance use and educational attainment.

"By controlling for all familial influences that contribute to both substance use and educational attainment, through our discordant twin design, we have a much stronger indicator of the direct association between substance use and educational attainment," she said. "However, because we were studying higher levels of education – 16+ years – in high school graduates, we may have understated the true effect of alcohol on education. It may be that these effects are more pronounced at even lower levels of education. Nonetheless, our findings lend credence to ongoing public health efforts to reduce adolescent smoking and drinking, which in turn may have beneficial effects on school dropout and lifelong educational attainment."

Posted by Webmaster at 07:07 PM


Ads Play Role in Underage Drinking

Minors who were familiar with television alcohol advertisements were more likely to have tried alcoholic beverages and binge drink than those who could not recall seeing such ads, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

"Underage drinking remains an important health risk in the U.S.," said lead author Susanne E. Tanski, MD, MPH, FAAP, assistant professor in the Department of Pediatrics at Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center. "In this study, we have shown a link between recognition of nationally televised alcohol advertisements and underage drinking initiation and heavier use patterns."

Promoting Risky Behaviors

Previous research by Dr. Tanski and her colleagues showed an association between seeing smoking and drinking in movies and adolescents engaging in these risky behaviors. This study expanded on that research by exploring whether there is an association between young people's exposure to television alcohol advertising and substance use.

The researchers surveyed a national sample of 2,541 youths ages 15 to 20 years. Participants were asked about their age, gender, race, if their friends drank, if their parents drank, whether they had a favorite alcohol ad and whether they owned alcohol-branded merchandise. They also were asked questions to assess whether they engaged in "sensation-seeking" behavior.

Participants then were shown 20 still images selected from television ads for the top beer and spirit alcohol brands that aired on national television in the year before the survey as well as 20 ads for fast-food restaurants. The images were digitally edited to remove the brands and logos. Individuals were asked if they remembered seeing the ad, if they liked the ad and if they knew the product or restaurant being advertised.

TV Ads and Teens

Results showed that 59 percent of underage youths previously drank alcohol. Of those who drank, 49 percent binge drank (had more than six drinks in a row) at least once in the past year.

Familiarity with TV alcohol advertising was significantly higher for drinkers than for non-drinkers. Other factors linked with drinking alcohol included older age, seeing alcohol in movies, having a favorite alcohol ad, having greater propensity for sensation seeking, having friends who drink alcohol, and having parents who drink alcohol at least weekly.

Among those who drank alcohol, familiarity with TV alcohol advertising was linked with greater alcohol use and binge drinking. Other factors linked with more hazardous drinking included owning alcohol-branded merchandise, having a favorite alcohol ad, older age, male gender, sensation seeking and friend drinking.

More Strict Standards Needed?

Familiarity with fast-food TV advertising was not linked to drinking behavior, suggesting that the relationship between alcohol ad familiarity and drinking is specific and not due to overall familiarity with advertising, Dr. Tanski said.

"At present, the alcohol industry employs voluntary standards to direct their advertising to audiences comprised of adults of legal drinking age," Dr. Tanski said. "Our findings of high levels of familiarity with alcohol ads demonstrate that underage youth still frequently see these ads. While this study cannot determine which came first — the exposure to advertising or the drinking behavior — it does suggest that alcohol advertising may play a role in underage drinking, and the standards for alcohol ad placement perhaps should be more strict."

Posted by Webmaster at 07:03 PM


Opioids Linked With Highest Risk of Death

People with an opioid addiction had the highest risk of death when compared with rates for alcohol and other drugs, according to a new study by the Centre for Addiction and Mental Health (CAMH). For those dependent on opioids, the risk of death was 5.71 times higher than healthy individuals in the population of the same age, gender and race.

Those with methamphetamine use disorders were next highest with a 4.67-fold risk, followed by those with addictions to cannabis (3.85), alcohol (3.83) and cocaine (2.96). Alcohol dependence was related to the highest number of deaths overall.

Mortality Rates Among Drug Users

The study, available online in the journal Drug and Alcohol Dependence, is the largest North American study to compare mortality rates among different drug users with the longest follow-up. It tracked records of more than 800,000 individuals hospitalized with drug dependence between 1990 and 2005. Of this group, more than 188,000 died during this period.

The findings mean that if 10 individuals in the general population died, then over the same period there would be 57 deaths among people dependent on opioids, which includes prescription opioids as well as heroin.

"One reason for undertaking this study was to examine whether methamphetamine posed a particular threat to drug users, as it has been called 'America's most dangerous drug,'" says CAMH Scientist Dr. Russell Callaghan, who led the study. Globally, methamphetamine and similar stimulants are the second most commonly used class of illicit drugs.

High Risk of Death

"The risk is high, but opioids are associated with a higher risk. We also wanted to compare mortality risks among several major drugs of abuse, as this comparison hasn't been done on this scale before."

Alcohol dependence affected the highest number of individuals, with 166,482 deaths and 582,771 hospitalizations over the study period. In the methamphetamine group, there were 4,122 deaths out of 74,139 hospitalizations, and for opioids, 12,196 deaths out of 67,104 hospitalizations.

Specific causes of mortality were not examined in this study, so the deaths may not be directly caused by drugs but due to related injuries, infectious disease or unrelated reasons. The researchers are now exploring mortality causes for each drug group, which may also point to reasons why women had a higher risk of death for alcohol, cocaine and opioids than males.

"These are not occasional, recreational drug users, but people who have been hospitalized for drug dependence," notes co-author Dr. Stephen Kish, Senior Scientist at CAMH.

To calculate mortality rates, Dr. Callaghan and colleagues examined hospital records of all California inpatients with a diagnosis of methamphetamine, alcohol, opioid, cannabis or cocaine-related disorders from 1990-2005. They excluded records with evidence of multiple drug use disorders. The inpatient records were then matched to death records from the California Vital Statistics Database. Rates were adjusted by age, sex and race to the California population in 2000.

Risk Greater for Marijuana Users

"One surprising finding was the high rate of death among cannabis users," says Dr. Callaghan. "There could be many potential reasons, including the fact that they may have other chronic illnesses such as psychiatric illnesses or AIDS, which can also increase the risk of death."

The findings point to the importance of brief interventions for people receiving medical care for drug dependence on other related risks such as infectious diseases or injuries, says Dr. Callaghan.

Posted by Webmaster at 06:59 PM


Chronic Cocaine Use Hastens Aging of Brain

Research by scientists at the University of Cambridge suggests that chronic cocaine abuse accelerates the process of brain ageing. The study, published in Molecular Psychiatry, found that age-related loss of grey matter in the brain is greater in people who are dependent on cocaine than in the healthy population.

For the study, the researchers scanned the brains of 120 people with similar age, gender and verbal IQ. Half of the individuals had a dependence on cocaine while the other 60 had no history of substance abuse disorders.

Loss of Brain Volume

The researchers found that the rate of age-related grey matter volume loss in cocaine-dependent individuals was significantly greater than in healthy volunteers. The cocaine users lost about 3.08 ml brain volume per year, which is almost twice the rate of healthy volunteers (who only lost about 1.69 ml per year). The accelerated age-related decline in brain volume was most prominent in the prefrontal and temporal cortex, important regions of the brain which are associated with attention, decision-making, and self-regulation as well as memory.

Previous studies have shown that psychological and physiological changes typically associated with old age such as cognitive decline, brain atrophy and immunodeficiency are also seen in middle-aged cocaine-dependent individuals. However, this is the first time that premature ageing of the brain has been associated with chronic cocaine abuse.

Premature Aging

Dr Karen Ersche, of the Behavioural and Clinical Neuroscience Institute (BCNI) at the University of Cambridge, said: "As we age, we all lose grey matter. However, what we have seen is that chronic cocaine users lose grey matter at a significantly faster rate, which could be a sign of premature ageing. Our findings therefore provide new insight into why the cognitive deficits typically seen in old age have frequently been observed in middle aged chronic users of cocaine."

The scientists also highlight concerns that premature ageing in chronic cocaine users is an emerging public health concern. The United Nations Office on Drugs and Crime estimates that cocaine is used by up to 21 million individuals worldwide, with approximately 1 per cent of these individuals becoming dependent.

Dr Ersche said: "Our findings clearly highlight the need for preventative strategies to address the risk of premature ageing associated with cocaine abuse. Young people taking cocaine today need to be educated about the long-term risk of ageing prematurely."

An Issue for Older Adults Too

The concern of accelerated ageing is not limited to young people but also affects older adults who have been abusing drugs such as cocaine since early adulthood.

Dr Ersche added: "Our findings shed light on the largely neglected problem of the growing number of older drug users, whose needs are not so well catered for in drug treatment services. It is timely for heath care providers to understand and recognise the needs of older drug users in order to design and administer age-appropriate treatments."

Posted by Webmaster at 06:55 PM


Teens Can Benefit From 12-Step Involvement

Adolescents who misuse alcohol and other drugs to the point where they need treatment must contend with costly and limited options for youth-specific care, as well as high relapse rates following treatment. Mutual-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are widely available but little research has addressed their benefits for adolescents. An assessment of 12-step meetings and recommended activities has found that attendance, participation, and finding a sponsor promote greater abstinence among adolescents.

Results will be published in Alcoholism: Clinical & Experimental Research.

Long-Term Recovery Support

"Most substance use disorder (SUD) treatment is short-term and relapse rates post-discharge are typically high without continued support," explained John F. Kelly, associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and associate professor in psychiatry at Harvard Medical School. "Mutual-help organizations such as AA and NA can help fill this gap, providing free and flexible long-term recovery support in the communities in which people live."

Kelly and his co-author assessed 127 adolescent outpatients (95 males, 32 females) aged 14-19 years old – who were enrolled in a naturalistic study of treatment effectiveness – at intake as well as at three, six, and 12 months later. Effects of the youths' attendance and active involvement in activities, such as contact with their sponsor, on their subsequent abstinence were tracked over time.

"We found that about one quarter to one third of the youth attended AA/NA throughout the year-long study period following treatment, and that more meeting attendance was associated with significantly better substance use outcomes – particularly attending meetings at least once per week or more," said Kelly. "Importantly, youth who also were in contact with an AA or NA sponsor or who participated verbally during AA/NA meetings had an even better outcome over and above the positive effects from merely attending. These findings support the common clinical recommendation that individuals should 'go to meetings, get a sponsor, and get active.' This is the first evidence to support this common clinical recommendation among young people."

Encouraging A.A. Attendance

Kelly suggested that medical practitioners, counselors, and other clinicians can enhance the likelihood that youth will attend and participate in AA/NA by encouraging or facilitating their attendance early in treatment.

"Starting an on-site NA or AA young person's meeting is another good idea," he added. "Not all youth will be motivated to attend, but the more severely substance-involved ones will be more likely to give meetings a try and these are the ones most likely to benefit. It is also a good idea to facilitate a good match between the patient's primary substance, cannabis/other drugs or alcohol, and the mutual-help organization to which they are being referred, Marijuana Anonymous, NA, or AA. Not doing this can lead to a poor initial match, which can be difficult to overcome."

Kelly said that one of the key elements to success in 12-step involvement is the creation of a personal connection between the patient and an existing community AA or NA member.

A.A. for Young People

"This community member can then make introductions, answer questions, and generally act as an initial guide and onsite facilitator," he said. "This is probably the most significant part of ensuring that young people get to their first meeting and have a positive experience – it's hard for anyone to walk in 'cold' to a large AA or NA meeting. Another possibility is for parents or counselors to take adolescents to meetings or to arrange to meet them at meetings to help facilitate attendance and engagement. Once there, young people report that they like the camaraderie and social affiliation offered at meetings; they appreciate knowing that they are not the only ones suffering from addiction problems, and they report liking the attention, care, and support they get at meetings."

Posted by Webmaster at 06:49 PM


Nurse-Delivered Alcohol Interventions More Accepted

The U.S. Joint Commission approved new hospital accreditation measures related to alcohol screening, brief intervention, and referral to treatment (SBIRT) for all hospitalized patients. Yet little is known about the effectiveness of brief interventions (BIs) or inpatient acceptability of SBIRT when performed by healthcare professionals other than physicians. A new study has found high hospital-patient acceptability of and comfort with nurse-delivered SBIRT.

Results were published in Alcoholism: Clinical & Experimental Research.

Identifying Unhealthy Alcohol Use

"SBIRT is widely endorsed for identifying and managing unhealthy alcohol use that ranges from hazardous or 'risky' drinking to the more serious alcohol abuse and dependence," explained Lauren M. Broyles, a research health scientist at the VA Pittsburgh Healthcare System, assistant professor of medicine at the University of Pittsburgh, and corresponding author for the study.

"A more recent focus has extended to identification of hazardous drinking – consumption that exceeds guidelines established by the National Institute on Alcohol Abuse and Alcoholism – as more than 14 standard drinks/week or more than four/occasion for men, and more than seven standard drinks/week or more than three/occasion for women and healthy individuals age 65 or older," she said. "Despite [supporting] evidence, recommendations and mandates concerning SBIRT implementation, uptake by healthcare providers in real-world clinical settings is still relatively limited."

"SBIRT is a brief conversation, about 10 to 15 minutes, about hazardous alcohol consumption," added Deborah S. Finnell, a research nurse scientist at the VA Western New York Healthcare System and associate professor of nursing at the University at Buffalo. "Healthcare team members could easily deliver SBIRT, assuming they are qualified. Since nurses provide 24-hour care in hospitals, nurses are most likely to have contact with patients compared with other healthcare team members, such as physicians and social workers."

High Rate of Acceptability

Broyles and her colleagues conducted a cross-sectional survey of 355 (342 males, 13 females) hospitalized medical-surgical patients at a large university-affiliated medical center that is part of the U.S. Department of Veterans Affairs.

Results indicated acceptability for nurse-delivered SBIRT was high. Patient acceptability for eight out of 10 individual nurse-delivered SBIRT tasks was greater than 84 percent. Roughly 20 percent of the patients reported some degree of personal discomfort with the discussions; in general these individuals had a lower belief in their ability to reduce their drinking risk, were older than 60 years of age, had a positive alcohol screening, and were of non-black race.

"We found, in general, that acceptability for nurse-delivered SBIRT tasks was associated with how people perceived their own alcohol-related risks," explained Broyles. "Patients had higher acceptability if they felt that they were able to determine and reduce their own alcohol-related health risks, and if they had expressed concern about their own alcohol use. Conversely, roughly 20 percent of the patients expressed annoyance or embarrassment with the questions while also showing high levels of acceptability. While this might seem contradictory, patients might feel embarrassed or uncomfortable with the topic or discussion even though they see the discussions as a legitimate, necessary, and acceptable part of the nurse's role."

Alcohol and Health Risks

"This study also highlights the importance of being patient-centered," said Finnell. "Patients are accepting of receiving information from nurses about changing their alcohol use and about self-help groups. Specifically, when patients can make the connection between their alcohol use and health risks, they may be more accepting of having the conversation with the nurse and continuing that conversation about decreasing the amount of alcohol they consume. Additionally, nurses providing patient-centered care will be sensitive to signs that the patient is uncomfortable during the conversation."

Broyles agreed. "For hazardous drinkers, nurses and other healthcare providers can normalize alcohol screening and BI by drawing analogies, for themselves and their patients, to screening and structured health behavior advice for other health conditions," she said. "Normalizing talk about unhealthy alcohol use and alcohol use disorders in general medical settings, by general medical providers, in general medical encounters in this way may help both providers and patients feel more comfortable."

Finnell said she was not surprised that patients were comfortable with nurse-delivered SBIRT. "I have been amazed at what patients share with me during my interactions with them," she said. "Americans consistently rank nurses 'very high' or 'high' on honesty and ethical standards. The concept of trust is an important element in the nurse-patient relationship."

Appropriate Training Needed

Both Broyles and Finnell emphasized the need for appropriate training, practice, support, and pragmatic strategies for incorporating alcohol SBIRT into existing clinical practices and routines. "Our findings suggest that once trained in SBIRT and motivational interviewing techniques, providers can proceed with greater confidence in alcohol-related risk assessment and risk-reduction conversations with patients," said Broyles.

"While this study focused on nurse-delivered SBIRT, the take-home points are highly relevant to other clinicians," added Finnell. "Clinicians who have been asked about barriers to delivering SBIRT report concern about jeopardizing their relationship with the patient. This study shows that patients are accepting of alcohol-related discussions, particularly brief counseling about alcohol, educational materials about changing alcohol use, and information about alcohol self-help groups. The findings from this study should alert nurses, physicians, and other health care providers to be prepared to meet the needs of these patients."

Posted by Webmaster at 06:45 PM


Alcohol Greatly Increases Serious Injury Risk

Researchers know that alcohol impairs coordination and the ability to perceive and respond to hazards, and that hangovers impair neurocognitive performance and psychomotor vigilance. This study closely examined alcohol-related injuries admitted to hospital, finding that alcohol greatly increases risk for serious injury.

Results were published in Alcoholism: Clinical & Experimental Research.

"We know that alcohol is more heavily involved in fatalities than injuries," said Ted R. Miller, a senior research scientist at the Pacific Institute for Research and Evaluation and corresponding author for the study. "It is less clear whether and how heavily alcohol is involved in serious injury."

Alcohol and Injuries

"It is important to understand the proportion of injury attributable to alcohol for those injuries which are more severe and subsequently hospitalized, compared to those not needing hospitalization," said Cheryl J. Cherpitel, a senior scientist with the Alcohol Research Group. "Taken together, both are important for a more comprehensive understanding of the proportional decline in injury in the absence of alcohol."

The study authors combined national alcohol consumption data with alcohol metabolism rates to estimate hours that heavy drinkers versus other drinkers and non-drinkers spent as "alcohol positive" versus "alcohol negative" within one calendar year.

"If we know how much alcohol people drink, we can estimate how many hours per day people are alcohol-positive versus alcohol-negative," explained Miller. "Dividing the number of alcohol-positive injuries by the number of alcohol-positive hours indicates injury-risk when alcohol-positive. A similar calculation gives the alcohol-negative risk."

Results showed that alcohol consumption is a major cause of hospitalized injury. Even though heavy drinkers generally lead risky lifestyles, and even though they tolerate alcohol better than most drinkers, their injury risks still tripled when they drank.

4.5 Times Higher Risk

"Risk during hours that people were alcohol-positive was 4.5 times their risk when sober," said Miller. "Heavy drinkers claim they can handle their alcohol. Within limits, that's true. Alcohol raises a heavy drinker's injury risk less than an average person's risk. Still, a heavy drinker is three times more likely to be injured during an alcohol-positive than a sober hour. Possibly due to hangover effects, heavy drinkers also are 1.35 times as likely as other people to be injured when sober. Alcohol especially raises risk for assault, near drowning, non-elderly fall, and pedestrian injuries. An estimated 36 percent of hospitalized assaults and 21 percent of all injuries are attributable to alcohol use by the injured person."

"Non-heavy drinkers also seem to have a higher risk of injury-related hospitalization when alcohol positive compared to alcohol-positive heavy drinkers," said Cherpitel, "likely due to their not being accustomed to alcohol's effects, while heavier drinkers have developed a tolerance to alcohol and are therefore less affected by the same amount of alcohol. It is also possible that heavier drinkers may have consumed so much alcohol that they are unable to place themselves in risky situations that may result in injury; for example, they may become a passenger in a vehicle and sleep rather than attempt to drive. These findings are similar to those from our emergency-room studies."

Warning Labels Needed

"Our estimates set the stage for injury-warning labels on alcohol bottles," said Miller. "They also suggest what percentage of public injury cost justifiably could be recovered through alcohol taxes. Moderate drinking has not traditionally been considered hazardous. Yet from an injury viewpoint, it appears to be more hazardous per drink than regular heavy drinking. Moderate drinkers who occasionally drink to excess suffer more injuries than heavy drinkers per alcohol-positive hour. Nonetheless, intervention rarely has been targeted to this group because its high risk was hidden."

"Certainly these findings point to the importance of screening and brief intervention in clinical practice," added Cherpitel, "as well as advancing public health knowledge regarding the potential effects of even small quantities of alcohol. Injury research needs to consider that even a small amount of alcohol in less experienced drinkers can be especially dangerous when undertaking potentially risky activities such as driving or using heavy equipment."

Posted by Webmaster at 06:40 PM


Smoking Reduction Quickly Lowers Death Rates

A study by the University of Liverpool has found that a decrease in smoking rapidly reduces mortality rates in individuals and entire populations within six months. Research by Professor Simon Capewell and Dr Martin O'Flaherty at the Institute of Psychology, Health and Well-being, examined evidence from clinical trials and natural experiments.

They found that a reduction in smoking has a positive impact on mortality rates in both individuals and populations within six months. Likewise, dietary improvements get very positive results within one to three years.

Benefits Happen Quickly

Professor Capewell said:"Our research found that smoking bans and diet improvements powerfully and rapidly reduce chronic disease in both individuals and in the wider population. This actually happens quickly, within a far shorter timescale than had previously been assumed; within months and years rather than decades. This discovery means that policies such as smoking bans or reducing saturated fats are effective at improving health and would save the NHS millions very rapidly."

The study found that policies that reduce smoking consistently have a rapidly positive effect on mortality rates and hospital admissions in countries and communities around the world. After smoke-free legislation was introduced in Scotland in 2006, hospital admissions for acute coronary syndrome decreased by 17% with a 6% decrease in out-of-hospital cardiac deaths.

Similarly, when smoke-free legislation was introduced in Helena, an isolated community in the US, it resulted in a 40% drop in admission rates for acute coronary syndrome within six months in one hospital. When the law was repealed the coronary admissions returned to previous levels within six months.

Diet Changes Help Too

Changes to diet also have a rapid and positive impact on the reduction of mortality rates for coronary heart disease. Coronary death rates rose steadily during the 20th Century, peaking in the 1970s in the UK, US and Western Europe. However, closer scrutiny of national trends revealed a notch in the early 1940s. This has been attributed to sudden decreases in dietary meat and animal fats due to food rationing during the Second World War.

More recently, a study of coronary disease in Poland found that death rates from heart disease had been rising steadily. From 1990, however, they quickly dropped by 25% after meat and animal fat subsidies from the communist countries ceased and cheap vegetable oils and fruit flooded the market. A study of other central European countries confirmed very similar trends.

Posted by Webmaster at 06:35 PM


Heavy Drinkers Have Poor Dietary Habits

Excessive drinking and an unbalanced diet are two preventable contributors to health problems in the developed world. Different studies have found varying linkages between amounts of alcohol consumed and quality of diet. A study of adults in Spain has found that heavy drinking, binge drinking, a preference for spirits, and drinking alcohol at mealtimes were associated with a poor adherence to major food consumption guidelines.

Results were published in Alcoholism: Clinical & Experimental Research.

"Drinking alcohol may reduce maintaining a healthy diet, leading to adverse metabolic effects which in turn add to those directly produced by alcohol," said José Lorenzo Valencia-Martín, a doctor at the Universidad Autónoma de Madrid and corresponding author for the study. "The specific influence of alcohol on diet may depend upon the overall quantity of alcohol ingested, frequency of consumption, beverage preference, and whether alcohol intake takes place during the meals. Alcohol may indirectly contribute to several chronic diseases such as obesity, diabetes mellitus, cardiovascular disease, or cancer."

Careless Dietary Habits

"Unhealthy lifestyles tend to cluster together, but this is not a 'necessary' association," added Miguel A. Martínez-González, chair of the department of preventive medicine and Public Health at the University of Navarra. "On average, people who drink excessive alcohol are more likely to be careless in their dietary habits. A high alcohol intake is especially unhealthy with respect to liver disease. A high-energy food pattern rich in trans fats – such as 'fast-foods' or items from a commercial bakery – is also likely to be related to liver disease. In this sense, if both unhealthy lifestyles cluster together, they can act synergistically to produce very adverse effects."


"In Spain, alcohol is frequently drunk during meals, particularly lunch and dinner," said Valencia-Martín. "Because of this, and the lower prevalence of abstainers, our findings apply to most adults in Spain and in other Mediterranean countries in Europe. Our results are of relevance because they show that drinking at mealtimes is associated with insufficient intake of healthy foods, such as fruits and vegetables, and with excessive intake of animal protein."

Unintended Consequences

From 2000 to 2005, the researchers carried out a telephone survey of 12,037 adults (5850 men, 6187 women) considered representative of 18-to-64-year-olds in the region of Madrid. Binge drinking was defined as equal to or more than 80 grams of alcohol for men and equal to or more than 60 grams for women during one drinking session; the threshold between moderate and heavy drinking was 40 grams of alcohol per day for men and 24 grams per day for women. Food consumption was measured using a 24-hour recall.

"Excessive drinkers, either with or without binge drinking, showed a poor adherence to dietary recommendations," said Valencia-Martín. "Although drinking at mealtimes has traditionally been considered a safe or even a healthy behavior, our results point to some unintended consequences that the general populations should be aware of. In particular, drinking at mealtimes is associated with poor adherence to most of the food consumption guidelines. Also, not all types of alcoholic beverages are equal with regard to their dietary effects; our results suggest that a preference for spirits is associated with a poorer diet. Lastly, the above implications apply to both men and women."

"I believe the key finding of this study is the suggestion of a harmful effect of binge drinking on healthy eating habits," said Martínez González. "Binge drinking prevalence was found to be relatively high – greater than 10 percent – in a representative sample of Spanish population. This is very bad news. Alcohol misuse has become a priority public-health problem in Spain, especially because of rising rates of binge drinking and especially because of the abandonment of the traditional Mediterranean pattern of moderate alcohol drinking, in little amounts, generally red wine during meals. Recent changes, especially among young Spanish people, include a pattern of high amounts of spirits during weekends. This excellent study adds another unfortunate consequence of this change: the impairment of eating habits."

Alcohol Replaces Healthy Calories

Martínez González added that both alcohol researchers and clinicians need to pay more attention to the dietary pattern of binge drinkers, and also consider that some of the detrimental effects attributed to alcohol might in fact be consequences of a poor diet.

"Don't forget that alcohol is addictive, that it replaces healthy calories from other foods by empty calories, meaning these calories are devoid of minerals and vitamins," said Martínez González. "Keep also in mind that the drinking pattern might be more important than the total amount consumed. The unhealthiest pattern is to consume high amounts – three to four drinks per day – of spirits or beer exclusively during the weekends. Conversely, the healthiest use of alcohol may be red wine, no more than one glass per day for women and two per day for men, and consumed during meals in a regular daily pattern."

Posted by Webmaster at 06:24 PM


How Alcohol Interferes With Sleep

Large amounts of alcohol are known to shorten sleep latency, increase slow-wave sleep, and suppress rapid eye movement (REM) during the first half of sleep. During the second half of sleep, REM increases and sleep becomes shallower. A study of the acute effects of alcohol on the relationship between sleep and heart rate variability (HRV) during sleep has found that alcohol interferes with the restorative functions of sleep.

Results were published in Alcoholism: Clinical & Experimental Research.

Alcohol affects overall sleep architecture," said Yohei Sagawa, a medical doctor in the department of neuropsychiatry at the Akita University School of Medicine. "Normally, during physiologic nocturnal sleep in humans, the parasympathetic nervous system, responsible for 'rest-and-digest' activities, is dominant over the sympathetic nervous system, responsible for stimulating activities. We wanted to investigate how alcohol may change this complementary relationship."

Unique Sleep-Alcohol Study

"I believe that the approach used in this study is unique," added Seiji Nishino, director of the Sleep & Circadian Neurobiology Laboratory at Stanford University School of Medicine. "Although there are several studies monitoring HRV during sleep, as far as I know there is no report describing the effects of alcohol on autonomic nervous system during sleep using this parameter."

Sagawa and his colleagues gave 10 healthy, male university students with a mean age of 21.6 years three different alcohol beverages at three week intervals: 0g (control), 0.5g (low dose), or 1.0g (high dose) of pure ethanol/kg of body weight. On the day of the experiment, a Holter electrocardiogram was attached to the subject for a 24-hour period; the subject was instructed to drink one of the three alcoholic beverages 100 minutes before going to bed; and polysomnography was then performed for eight hours. Power spectral analysis of the HRV was performed using the maximum entropy method, and the low- and high-frequency components along with their ratios were calculated.

"Our study showed that alcohol suppresses the high-frequency power during sleep in a dosage-dependent manner," said Sagawa. "Although the first half of sleep after alcohol intake looks good on the EEG, the result of the assessment regarding the autonomic nerve system shows that drinking leads to insomnia rather than good sleep."

Heart Rate Increase

More specifically, as alcohol consumption increased, the heart rate increased and the spectral power of HRV measured at each frequency range decreased. Also, the low-frequency/high-frequency ratio that is considered an index of the balance between the sympathetic and parasympathetic systems was increased. This suggests that alcohol, in a dosage-dependent manner, suppresses the high-frequency component of HRV that is an indicator of parasympathetic nerve activity during sleep.

"The current study evaluates the acute effects after only a single dose of alcohol intake, and subsequently found a negative health consequence," observed Nishino. "Many subjects habitually drink alcohol, and if the reduction of parasympathetic nerve activity during sleep chronically occurred, negative health consequences may be much larger and may induce various diseases. It is reported that habitual drinkers with hypertension are often associated with reductions of parasympathetic nerve activities."

Many Alcoholics Have Insomnia

Sagawa agreed. "Many alcoholics and habitual drinkers suffer from insomnia," he said. "Suppressed parasympathetic nerve activity is the result of alcohol drinking. Thus, it is inferred that suppressed parasympathetic nerve activity is associated with insomnia, which includes difficulty getting to sleep, early-morning awakening, lack of a sense of deep sleep, and difficulty maintaining sleep."

"It is generally believed that having a nightcap may aid sleep, especially sleep initiation," said Nishino. "This may be true for some people who have small amounts of alcohol intake. However, it should be noted that large amounts of alcohol intake interfere with sleep quality and the restorative role of sleep and these negative consequences may be much larger during chronic alcohol intake."

Sagawa added that it is important for clinicians who are treating physical and psychological disorders related to alcohol to consider the disturbing effects on sleep's restorative effects that habitual drinking can have.

Posted by Webmaster at 06:19 PM


Brain Damage Seen in Young Binge-Drinkers

It's considered a rite of passage among young people – acting out their independence through heavy, episodic drinking. But a new University of Cincinnati study, the first of its kind nationally, is showing how binge drinking among adolescents and young adults could be causing serious damage to a brain that's still under development at this age.

Researcher Tim McQueeny, a doctoral student in the UC Department of Psychology, is presenting the findings this week at the 34th annual meeting of the Research Society on Alcoholism in Atlanta.

Binge Drinking and the Brain

High-resolution brain scans on a sample of 29 weekend binge drinkers, aged 18 to 25, found that binge-drinking – consuming four or more drinks in one incident for females and five or more drinks for males – was linked to cortical-thinning of the pre-frontal cortex, the section of the brain related to executive functioning such as paying attention, planning and making decisions, processing emotions and controlling impulses leading to irrational behavior.

McQueeny examined the brain's gray matter, the parts of brain cells that do the thinking, receiving and transmitting of messages. "We have seen evidence that binge drinking is associated with reduced integrity in the white matter, the brain's highways that communicate neuron messaging, but alcohol may affect the gray matter differently than the white matter," he says.

The pilot study examined whether the researchers could see a relationship between gray matter thickness and binge drinking among college-aged young adults. They found that greater number of drinks per binge is associated with cortical thinning. McQueeny is now interested in pursuing future research to examine whether binge drinking is affecting the brain's gray matter and white matter differently, or if they're both equally affected.

Brain Is Still Growing

"Alcohol might be neurotoxic to the neuron cells, or, since the brain is developing in one's 20s, it could be interacting with developmental factors and possibly altering the ways in which the brain is still growing," he says.

The findings affect a significant population. A publication from the National Institute on Drug Abuse reports that 42 percent of young American adults between 18 and 25 have engaged in binge drinking.

McQueeny adds that the depressant effects of alcohol emerge later in life, so for young adults, the effect of alcohol can be very stimulating and activate tolerance over time.

"In the past, in terms of what's known about the physical toll of alcohol, the focus on neurobiology has been in pathological populations and adult populations who were disproportionately male, so there was a significant gap in research in terms of when people started risky drinking. We're looking at developmental aspects at an age when binge drinking rates are highest, and we're also looking at gender effects," says McQueeny. "There might actually be indications of early micro-structural damage without the onset of pathological symptoms such as abuse, or dependence on alcohol."

Resonsible Drinking Suggested

McQueeny's advisor, UC Psychology Professor Krista Lisdahl Medina, served as senior author on the paper. She adds, "Our preliminary evidence has found a correlation between increased abstinence of binge drinking and recovery of gray matter volume in the cerebellum. Additional research examining brain recovery with abstinence is needed."

In terms of educating young adults about responsible drinking, Medina says there appear to be better efforts about communicating the dangers of drinking and driving. "However, people can still be doing damage to their brain as a result of the prevalence and acceptance of binge drinking. There is also evidence that drinking below the binge level may be less harmful," she says.

The high-resolution imaging was conducted at UC's Center for Imaging Research.

The research was supported by a $300,000 grant awarded to Medina's lab by the National Institute on Drug Abuse. McQueeny was also awarded a University Research Council Summer Graduate Fellowship.

Posted by Webmaster at 12:14 PM


Alcohol's Damaging Effects on the Brain

While alcohol has a wide range of pharmacological effects on the body, the brain is a primary target. However, the molecular mechanisms by which alcohol alters neuronal activity in the brain are poorly understood. Participants in a symposium at the annual meeting of the Research Society on Alcoholism in San Antonio, Texas addressed recent findings concerning the interactions of alcohol with prototype brain proteins thought to underlie alcohol actions in the brain.

Proceedings were published in Alcoholism: Clinical & Experimental Research.

Effects of Alcohol on the Brain

"Alcohol is the most common drug in the world, has been used by diverse human communities longer than recorded history, yet our understanding of its effects on the brain is limited when compared to other drugs," said Rebecca J. Howard, a postdoctoral fellow at The University of Texas at Austin Waggoner Center for Alcohol & Addiction Research and corresponding author for this study.

Howard explained that neuroscientists have discovered how marijuana, cocaine, and heroin each bind to a special type of protein on the surface of brain cells, fitting like a key into a lock to change that protein's normal function. Yet alcohol has special properties that make it difficult to characterize its lock-and-key binding in detail, for example, alcohol is much smaller than other drugs, and appears to interact with several different types of proteins.

"The adverse effects of alcohol abuse are devastating on a personal level and on a societal level," added Gregg Homanics, a professor of anesthesiology and pharmacology & chemical biology at the University of Pittsburgh. "Alcohol abuse costs our society more than the costs of all illegal drug abuse combined. For many years, most investigators thought that alcohol exerted nonspecific effects on the brain and simply perturbed neuronal function by dissolving in the membranes of nerve cells. However, our understanding of alcohol action has dramatically shifted in the last 10 to 15 years or so. There is now solid experimental evidence that alcohol binds in a very specific manner to key protein targets in the brain to cause the drug's well known behavioral effects. This review summarizes some of the most recent research."

Recent Alcohol Research

Some of the key points were:

Combining X-ray crystallography, structural modeling, and site-directed mutagenesis may be better suited to studying alcohol's low-affinity interactions than traditional techniques such as radioligand binding or spectroscopy.

"One major problem in studying alcohol binding to brain proteins is that the alcohol key does not fit very tightly into any particular protein lock," said Howard. "That is, alcohol has a 'low affinity' for proteins, compared to how other drugs interact with their own protein targets. We think this is one reason it takes such a large quantity of alcohol to affect the brain: whereas users of cocaine or heroin may consume just a few milligrams at a time, a person drinking a shot of strong liquor consumes about 1,000 times that much alcohol (several grams). The low affinity of alcohol for its protein targets [also] makes it difficult to study by traditional methods that rely on detecting stable drug-protein complexes over a long period of time."

Some common themes are beginning to emerge from a review of diverse proteins such as inwardly rectifying potassium, transient receptor potential, and neurotransmitter-gated ion channels, as well as protein kinase C epsilon.

Alcohol Targets in the Brain

"It is now very clear that hydrophobic pockets exist in the structure of various brain proteins and alcohols can enter those pockets," said Homanics. "Alcohols interact with specific amino acids that line those pockets in a very specific manner."

In particular, evidence is emerging that supports characteristic, discrete alcohol binding sites on protein targets.


"Different drugs bind to different types of proteins on the surface of brain cells, each fitting like a key, or drug, into a lock, or binding site, on a protein to change its normal function," explained Howard. "Understanding the exact shape of that lock and key helps us to understand how individuals with special mutations may be affected differently by drugs, and can help scientists design new medicines to help people with drug abuse or other problems."

The Brain's Binding Sites

"I feel that there is now overwhelming evidence that specific alcohol binding sites exist on a variety of brain protein targets," added Homanics. "This is significant because we can now focus on defining these sites in greater detail, ultimately at the level of each atom involved. This will allow for, one, a more complete understanding of the molecular pharmacology of alcohol action, two, the discovery of similar sites on other important brain proteins, and three, the rational design of drugs that can selectively target these binding sites."

"Our review summarizes very recent advances in understanding the molecular details of alcohol binding sites, which now include human brain targets, not just metabolic enzymes and receptors from other species," said Howard. "This information will give researchers new opportunities to characterize human mutations and design new medicines. Furthermore, common themes emerging about alcohol binding sites may help scientists identify important binding sites in other important brain proteins."

Highly Selective Targets

"In other words," said Homanics, "alcohol exerts its effects via binding sites on target molecules just like all other drugs we know about. There is now solid evidence from several different putative alcohol targets using several different techniques that alcohol interacts with specific brain targets in a highly selective manner. This is particularly important for more senior clinicians and researchers that were trained years ago when the predominant theory of alcohol action was via nonspecific effects on the nervous system." Both Howard and Homanics are hopeful that this research will aid the development of therapies and treatments for individuals with alcohol problems.

"Great progress is being made in understanding how alcohol exerts its effects on the brain at the molecular level," noted Homanics. "Understanding how alcohol affects brain proteins on a molecular level is essential if we are to effectively develop rational treatments to combat alcohol use disorders."

Posted by Webmaster at 12:10 PM


Binge Drinking Affects Ability to Learn

Binge drinking is prevalent among university students, especially in the United States. One brain structure particularly sensitive to alcohol's neurotoxicity during development is the hippocampus, which plays a key role in learning and memory. A study of the association between binge drinking and declarative memory – a form of long-term memory – in university students has found a link between binge drinking and poorer verbal declarative memory.

"In northern European countries, there is a strong tradition of a sporadic, drunkenness-orientated, drinking style," explained María Parada, a postdoctoral researcher at the Universidade de Santiago de Compostela, Spain and first author of the study. "In contrast, countries on the Mediterranean coast, such as Spain, have traditionally been characterized by a more regular consumption of low doses of alcohol. In recent years, the pattern of binge drinking among young people has become more widespread throughout Europe, hence the growing concern about this issue."

Binge Drinking and Memory

"I think it´s important to examine alcohol´s effects on the hippocampus because in animal studies, particularly in rats and monkeys, this region appears sensitive to the neurotoxic effects of alcohol, and this structure plays a main role in memory and learning," said Marina Rodríguez Álvarez, a senior researcher at the Universidad de Santiago de Compostela. "In other words, binge drinking could affect memory of young adults, which might affect their day-to day lives."

"Our interest in studying the effects of binge drinking patterns on declarative memory results from the well-established role of the hippocampus – a small seahorse-shaped brain structure located in the medial regions of the cerebral hemispheres – in this cognitive function," added Parada. "Both animal studies as well as some neuroimaging studies in humans have shown the hippocampus to be particularly vulnerable to the effects of alcohol, so we wondered whether hippocampus-dependent learning and memory could be affected by heavy episodic drinking."

Parada and her colleagues examined 122 Spanish university students between 18 and 20 years of age divided into two groups: those who engaged in binge drinking (n=62; 32 men, 30 women) and those who did not (n=60; 31 men, 29 women). All were administered a neuropsychological assessment that included the Rey Auditory Verbal Learning Test and the Wechsler Memory Scale-3rd ed. (WMS-III) Logical Memory subtest to measure verbal declarative memory, as well as the WMS-III Family Pictures subtest to measure visual declarative memory.

College Students Affected

"Our main finding was a clear association between binge drinking and a lower ability to learn new verbal information in healthy college students, even after controlling for other possible confounding variables such as intellectual levels, history of neurological or psychopathological disorders, other drug use, or family history of alcoholism," said Parada.

"Young adults with a binge drinking pattern of alcohol consumption who have poorer verbal declarative memory will need more neural resources to perform memory tasks and to learn new information, which probably would affect their academic performance," observed Rodríguez Álvarez.

Parada was a little more cautious. "Although it seems reasonable to expect that these differences in declarative memory affect academic performance – because it depends on the ability to learn new information – there are many other variables that may modulate and explain this relationship, for example, student effort or class attendance," she said. "We are currently carrying out a longitudinal study of these young people, and collecting information on their academic achievements, so we hope to be able to answer this question more definitively in the near future."

One of the strengths of this study, added Parada, is that it controlled for confounding variables such as psychiatric comorbidity, genetic vulnerability, or other drug use, such as marijuana. "This allowed us to establish a clearer association between binge drinking patterns and poorer performance on memory tasks," she said.

An additional strength, said Rodríguez Álvarez, was the finding that women are not more vulnerable than men to the neurotoxic effects of binge drinking.

Both Parada and Rodríguez Álvarez noted the importance of prevention programs and policies to address this issue.

Low Perception of Risk

"One of the factors that appear to be behind this pattern of consumption is the low perception of risk," said Parada. "Whereas most attention has focused on negative consequences such as traffic accidents, violence or public disorder, society and students themselves are unaware of the damaging effects binge drinking may have on the brain. Policies and prevention programs in Europe aimed at controlling this pattern of consumption on campus are still rare."

Yet the opposite should be occurring, added Rodríguez Álvarez. "These results should be taken into account by parents, clinicians, university administrators, and also governments because it is vital to address all that surrounds the brain's development in our adolescents and young adults."

Results were published in Alcoholism: Clinical & Experimental Research.

Posted by Webmaster at 12:04 PM


Parents Have Role in Smoking Prevention

Parents shouldn't let up when it comes to discouraging their kids from smoking. That's the message of a study presented at the Pediatric Academic Societies (PAS) annual meeting in Denver.

Previous research has shown that parents can deter adolescents from smoking by monitoring them and enforcing anti-smoking practices at home. Researchers, led by E. Melinda Mahabee-Gittens, MD, an emergency medicine physician at Cincinnati Children's Hospital Medical Center, sought to determine if family factors continue to protect adolescents as they grow older and whether these factors affect youths of varying racial/ethnic backgrounds differently.

Family Factors in Smoking

Investigators studied 3,473 pairs of white, black and Hispanic parents and nonsmoking youths who participated in the National Survey of Parents and Youth in November 1999-June 2001 (Time 1) and again in July 2002-June 2003 (Time 2). They looked at whether youths remained nonsmokers throughout the study period, and they assessed changes in family factors thought to protect against smoking initiation over time.

Results showed no differences in the rate of smoking initiation between Time 1 and Time 2 by race. In addition, youths in all three racial/ethnic groups reported associating more with peers who smoked at Time 2 than at Time 1.

The levels of protective family factors decreased significantly from Time 1 to Time 2 across all racial/ethnic groups in both smokers and nonsmokers. However, levels of protective factors were consistently higher in nonsmoking youths compared to smokers. Continued, higher levels of connectedness and monitoring by parents decreased the risk of smoking initiation by as much as 30 percent in both whites and Hispanics.

Increased Risk of Smoking

Meanwhile, decreases in the following family factors from Time 1 to Time 2 were associated with an increased risk that youths would start smoking: 1) punishment: up to 43 percent increased risk in all three racial/ethnic groups; 2) monitoring: 42 percent increased risk in blacks only; and 3) connectedness: up to 26 percent increased risk in both blacks and Hispanics.

"Even though the level of protective family factors decreased as youth grew older, they remained important in continuing to protect against smoking initiation," said Dr. Mahabee-Gittens, who is also associate professor of pediatrics at the University of Cincinnati. "These findings support smoking prevention interventions that encourage parents of all three racial/ethnic groups to enforce consistent consequences of smoking behavior, and encourage continued monitoring and connectedness in minority groups."

Posted by Webmaster at 12:00 PM


Adult-supervised Teen Drinking Can Backfire

Allowing adolescents to drink alcohol under adult supervision does not appear to teach responsible drinking as teens get older. In fact, such a "harm-minimization" approach may actually lead to more drinking and alcohol-related consequences, according to a study in the Journal of Studies on Alcohol and Drugs.

"Kids need parents to be parents and not drinking buddies," according to the study's lead researcher, Barbara J. McMorris, Ph.D., of the School of Nursing at the University of Minnesota. Allowing adolescents to drink with adults present but not when unsupervised may send mixed signals. "Adults need to be clear about what messages they are sending."

Drinking Responsibly?

In general, parents tend to take one of two approaches toward teen drinking. Some allow their adolescent children to consume alcohol in small amounts on occasion if an adult is present. The thinking is that teens will learn to drink responsibly if introduced to alcohol slowly in a controlled environment. This has been the predominant approach in many countries, including Australia.

A second approach is one of "zero tolerance" for youth drinking, meaning that teens should not be allowed to drink alcohol under any circumstances. This less permissive position is predominant in the United States, with local laws and national policies often advocating total abstinence for adolescents.

Alcohol-Related Consequences

To test how these different approaches are related to teen drinking, McMorris and colleagues from the Centre for Adolescent Health in Melbourne, Australia, and the Social Development Research Group in Seattle surveyed more than 1,900 seventh graders. About half were from Victoria, Australia; the rest were from Washington State. From seventh to ninth grade, investigators asked the youths about such factors as alcohol use, problems they had as a result of alcohol consumption, and how often had they consumed alcohol with an adult present.

By eighth grade, about 67% of Victorian youths had consumed alcohol with an adult present, as did 35% of those in Washington State, reflecting general cultural attitudes. In ninth grade, 36% of Australian teens compared with 21% of American teens had experienced alcohol-related consequences, such as not being able to stop drinking, getting into fights, or having blackouts. However, regardless of whether they were from Australia or the United States, youths who were allowed to drink with an adult present had increased levels of alcohol use and were more likely to have experienced harmful consequences by the ninth grade.

The researchers suggest that allowing adolescents to drink with adults present may act to encourage alcohol consumption. According to the authors, their results suggest that parents adopt a "no-use" policy for young adolescents. "Kids need black and white messages early on," says McMorris. "Such messages will help reinforce limits as teens get older and opportunities to drink increase."

Alcohol Available in the Home

In a related study in the May issue of JSAD, researchers from The Netherlands found that, among 500 12- to -15-year olds, the only parenting factor related to adolescent drinking was the amount of alcohol available in the home. In fact, the amount of alcohol parents themselves drank was not a factor in adolescent drinking. These results suggest that parents should only keep alcohol where it is inaccessible to teens. In addition, parents should "set strict rules regarding alcohol use, particularly when a total absence of alcoholic drinks at home is not feasible," according to lead researcher Regina van den Eijnden, Ph.D., of Utrecht University in The Netherlands.

"Both studies show that parents matter," McMorris concludes. "Despite the fact that peers and friends become important influences as adolescents get older, parents still have a big impact."

Posted by Webmaster at 11:56 AM


Parental Alcoholism Linked to Offspring's Alcoholism

Researchers know that there is a strong link between parental alcohol use disorders and the risk for developing an alcohol use disorders among their offspring. This study looked at the risk of alcohol use disorders in the offspring of a large population-based sample of Danish parents. Findings confirmed that parental alcohol use disorders were associated with an increased risk of alcohol use disorders among the offspring.

"Few studies have used a broad population-based approach to examine associations between a parental history of alcohol use disorders and risk of an alcohol use disorders in offspring," said Erik Lykke Mortensen, associate professor in medical psychology at the University of Copenhagen and corresponding author for the study. "Longitudinal population studies are both expensive and take a long time to complete. In some countries it may also be a problem to follow several generations through decades. But in Denmark we have personal identification numbers and national health registries."

Population Based Study

Mortensen and his colleagues gathered data on 7,177 individuals (3,627 men, 3,550 women) born in Copenhagen between October 1959 and December 1961: information on alcohol use disorders was gathered from three Danish health registers, and information on other psychiatric disorders (OPDs) was gathered from the Danish Psychiatric Central Register. Offspring registration with an alcohol use disorders was analyzed in relation to parental registration with an alcohol use disorders and/or OPD. The gender of the offspring and parental social status were also noted.

Results showed that parental alcohol use disorders were associated with an increased risk of alcohol use disorders among the offspring, independent of other significant predictors such as gender, parental social status, and parental psychiatric hospitalization with other diagnoses.

"Furthermore, this association appeared to be stronger among female than male offspring, which suggests that inherited factors related to alcohol use disorders are at least as important among daughters as among sons," said Mortensen. "This finding is important because some early studies suggested that a genetic load played a stronger role in males than in females."

Increased Risk for Alcoholism

One of the important aspects of this study, added Mortensen, is that contrary to a number of previous adoption and twin studies – often based on relatively small and selected samples – these findings represent risk estimates from a population-based study.

"The key message for the general public is that there is an increased risk associated with parental alcoholism," said Mortensen, "but obviously many other factors determine whether an individual develops an alcohol use disorder."

Results were published in Alcoholism: Clinical & Experimental Research.

Posted by Webmaster at 11:54 AM


Doctors Lax in Monitoring Addicting Drugs

Few primary care physicians pay adequate attention to patients taking prescription opioid drugs — despite the potential for abuse, addiction and overdose, according to a study by researchers at Albert Einstein College of Medicine of Yeshiva University.

The study, published in the Journal of General Internal Medicine, found lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence. The findings are especially concerning considering that prescription drug abuse now ranks second (after marijuana) among illicitly used drugs, with approximately 2.2 million Americans using pain relievers nonmedically for the first time in 2009, according to the National Institute on Drug Abuse (NIDA).

Missed Prevention Opportunity

"Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings," said lead author Joanna Starrels, M.D., M.S. , assistant professor of medicine at Einstein. "The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring."

The researchers studied administrative and medical records of more than 1,600 primary care patients for an average of two years while they received regular prescription opioids for chronic, non-cancer pain. They looked at whether patients received urine drug testing, were seen regularly in the office, or received multiple early opioid refills.

Few Given Urine Tests

Only a small minority (8 percent) of patients were found to have undergone any urine drug testing. While such testing was more common in patients at higher risk for opioid misuse, the rate of testing among those high-risk patients was still low (24 percent). Only half of patients were seen regularly in the office, and patients at higher risk of opioid misuse were not seen more frequently than patients at lower risk. Although fewer than one-quarter (23 percent) of all patients received two or more early opioid refills, patients at greater risk for opioid misuse were more likely to receive multiple early refills.

"We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders," said Dr. Starrels. "We hope that these findings will call attention to this important safety concern."

Prescription Drug Misuse Problem

Prescription drug misuse is a major public health problem. In a 2004 NIDA report , it was estimated that 48 million people over the age of 12 have taken prescription drugs for nonmedical uses in their lifetime – which represents approximately 20 percent of the U.S. population. Opioids, central nervous system depressants and stimulants were the drugs most commonly abused.

"Most primary care physicians are attuned to these problems," said Dr. Starrels, "but they haven't put sufficient strategies in place to help reduce risks." She and her co-authors recommend that physicians adopt the following risk-reduction strategies: standardize a plan of care for all patients on long-term opioids, which includes urine drug testing; schedule regular face-to-face office visits to evaluate patients' response to opioids and evidence of misuse; and stick to a previously agreed-upon refill schedule.

Posted by Webmaster at 11:49 AM


Many Kids Get Their Alcohol at Home

A study by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 5.9 percent of adolescents aged 12 to 14 drank alcohol in the past month and that the vast majority of them (93.4 percent) received their alcohol for free the last time they drank.

About 317,000 (44.8 percent) 12 to 14 year olds who drank in the past month received their alcohol for free from their family or at home. This includes 15.7 percent (or an estimated 111,000) who were provided alcohol for free by their parents or guardians.

Increased Risk for Alcoholism



"People who begin drinking alcohol before the age of 15 are six times more likely than those who start at age 21 and older to develop alcohol problems. Parents and other adults need to be aware that providing alcohol to children can expose them to an increased risk for alcohol abuse and set them on a path with increased potential for addiction," said SAMHSA Administrator Pamela S. Hyde, J.D.

SAMHSA Data Spotlight: Young Alcohol Users Often Get Alcohol from Family or Home is based on the combined data from SAMHSA’s 2006 to 2009 National Surveys on Drug Use and Health (NSDUH) and involves responses from more than 44,000 respondents ages 12 to 14.

NSDUH is a primary source of information on national use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States. The survey is part of the agency’s strategic initiative on behavioral health data, quality and outcomes.

Posted by Webmaster at 11:44 AM


Alcohol Can Increase Risk of Atrial Fibrillation

A review of research studies indicate that alcohol consumption can increase the risk for developing atrial fibrillation. Atrial Fibrillation (AF) is the most common cardiac arrhythmia (abnormal heart rhythm). Its name comes from the fibrillating (i.e., quivering) of the heart muscles of the atria, instead of a coordinated contraction.

The result is an irregular heartbeat, which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. Atrial fibrillation alone is not in itself generally life-threatening, but it may result in palpitations, fainting, chest pain, or congestive heart failure.

There is no doubt that heavy alcohol intake and binge drinking can lead to cardiac arrhythmias, with the "Holiday Heart Syndrome" being known for more than three decades. This syndrome often includes atrial fibrillation; the syndrome is usually not associated with long-standing heart disease and the arrhythmia tends to resolve when drinking stops.

Heavy Drinking and Atrial Fibrillation

Members of The international Scientific Forum on Alcohol Research comment 'This paper, Alcohol consumption and risk of atrial fibrillation. A meta-analysis. J Am Coll Cardiol 2011;57:427-436. analyzing the results of 14 papers suggests that even moderate drinking can lead to this syndrome, but others find no effect for moderate alcohol intake, only for heavy drinking.

One of the best studies on alcohol consumption and risk of atrial fibrillation is a Danish cohort study (the Danish Diet, Cancer and Health Study) examining the issue among 22,528 men and 25,421 women followed over 6 years. The study included a large number of cases with atrial fibrillation, detailed information on potential confounding factors, and complete follow up through nationwide population-based registries.

The results included a modest increase in risk of atrial fibrillation in men drinking more that 2 drinks/day and no association between alcohol consumption and risk of atrial fibrillation in women.

Binge Drinking Dangers

There is much evidence that heavy alcohol consumption is associated with an increased incidence of atrial fibrillation, among other health risks. The pattern of consumption (speed, time frame and without food), not often addressed, affects risk too - we know that binge drinking is associated with a greater incidence of arrhythmias, especially atrial fibrillation.

A weakness of this paper, and of essentially all meta-analyses, is that there were varying definitions for categories of alcohol consumption, and the highest category of alcohol intake included alcoholics and 6 or more drinks/day for some studies, while the highest category of alcohol intake was = 1-2 drinks/day in other studies.

Inherent Health Risk

The consistent message is that there is a difference between heavy and moderate use of alcohol, between binge drinking and a healthy pattern of drinking, and inherent health risk. The most important question would be: Does light to moderate drinking increase the risk of AF? The conclusion of the authors of this paper seems to be yes, while many other studies find little effect of such drinking'.

Overall, the scientific evidence from many studies suggests that heavy drinking may increase the risk of atrial fibrillation, although whether light-to-moderate intake increases the risk seems unlikely. Previous basic scientific data of mechanisms of atrial fibrillation have suggested that alcohol has little effect on this arrhythmia.

Posted by Webmaster at 11:40 AM


Alcohol's Effects on Women's Sleep More Pronounced

Researchers have known for decades that alcohol can initially deepen sleep during the early part of the night but then disrupt sleep during the latter part of the night; this is called a "rebound effect." A study of the influence of gender and family history of alcoholism on sleep has found that intoxication can increase feelings of sleepiness while at the same time disrupt actual sleep measures in healthy women more than in healthy men.

Results will be published in the May 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Alcohol Disrupts Later Sleep


"It's clear that a substantial portion of the population uses alcohol on a regular basis to help with sleep problems," said J. Todd Arnedt, assistant professor of psychiatry and neurology at the University of Michigan and lead author of the study. "This perception may relate to the fact that alcohol helps people fall asleep quickly and they may be less aware of the disruptive effects of alcohol on sleep later in the night."

Arnedt said that his group decided to examine gender differences in the effects of alcohol on sleep because very few alcohol administration studies have included female participants and, since women metabolize alcohol differently than men, it seemed reasonable to expect differences by gender.

"Our decision to examine family history was based on some observational studies showing different sleep characteristics among family-history positive participants compared to family-history negative participants," he explained. "Family-history positive individuals also seem to be more resistant to the acute intoxicating effects of alcohol than individuals without a family history of alcoholism."

Women More Effected Than Men


Arnedt and his colleagues recruited 93 healthy adults (59 women, 34 men) in their twenties through advertisements in the Boston area, 29 of whom had a positive family history of alcoholism. Between 8:30 and 10:00 p.m., participants consumed either a placebo beverage or alcohol to the point of intoxication as determined by breath alcohol concentration (BrAC). Their sleep was then monitored with polysomnography between 11:00 p.m. and 7:00 a.m. Participants also completed questionnaires at bedtime and upon awakening.

"Alcohol increased self-reported sleepiness and disrupted sleep quality more in women than men," said Arnedt. "Sleep quality following alcohol did not differ between family-history positive and family-history negative subjects. Morning ratings of sleep quality were worse following alcohol than placebo. Findings also confirmed results from other studies that a high dose of alcohol solidifies sleep in the first half of the night, meaning more deep sleep, but disrupts it in the second part of the night, meaning more wakefulness."

With respect to gender differences, women objectively had fewer hours of sleep, woke more frequently and for more minutes during the night, and had more disrupted sleep than men.

Metabolism May Be Key


"These differences may be related to differences in alcohol metabolism," explained Arnedt, "since women show a more rapid decline in BrAC following alcohol consumption than men. It is important to note that the peak BrACs were equivalent between men and women in our study so the findings are not due to higher BrACs among the female subjects. We also do not believe that the differences were due to differences in alcohol experience because the prior alcohol use was also equivalent between the men and women."

In summary, said Arnedt, this study's primary contribution was to demonstrate that the effects of alcohol on objectively measured sleep quality are different between men and women at equivalent BrACs.

"These findings may have implications for future studies examining the relationship between sleep quality and risk for the development of alcohol use disorders, as well as studies evaluating how sleep quality relates to relapse among recovering alcoholic individuals," he said.

Posted by Webmaster at 11:34 AM


Helping Others Helps Alcoholics Stay in Recovery

Participating in community service activities and helping others is not just good for the soul; it has a healing effect that helps alcoholics and other addicts become and stay sober, a researcher from Case Western Reserve University School of Medicine reports.

In a review article published in the Volume 29 issue of Alcoholism Treatment Quarterly, Maria E. Pagano, PhD, associate professor of psychiatry at the School of Medicine, sheds light on the role of helping in addiction recovery, using the program of Alcoholics Anonymous (AA) as a prime example.

Service Works Helps Alcoholics

She cites a growing body of research as supporting evidence. “The research indicates that getting active in service helps alcoholics and other addicts become sober and stay sober, and suggests this approach is applicable to all treatment-seeking individuals with a desire to not drink or use drugs,” Dr. Pagano says. “Helping others in the program of AA has forged a therapy based on the kinship of common suffering and has vast potential.”

In her research, Dr. Pagano highlights the helper therapy principle (HTP), a concept embodied by AA, as a means of diminishing egocentrism or selfishness, a root cause of addiction. The HTP is based on the theory that, when a person helps another individual with a similar condition, they help themselves. The principle is reflected in the stated purpose of AA, which is to help individuals “stay sober and help other alcoholics achieve sobriety.”

Helping other alcoholics is viewed as the foundation for the alcoholic helper to stay on the path to recovery, Dr. Pagano says in her overview of the AA program. In addition to outlining the basis for AA-related helping, Dr. Pagano reviews the data to date that illustrates the health and mental health benefits derived from helping others.

Helping Others Helps You


She likewise examines several empirical studies she conducted previously which show how helping others in 12-step programs of recovery help the recovering individual to stay sober. The research includes a 2004 study by Dr. Pagano and her colleagues. Using data from Project MATCH, one of the largest clinical trials in alcohol research, the investigators determined that 40 percent of the alcoholics who helped other alcoholics during their recovery successfully avoided drinking in the 12 months following three months in chemical dependency treatment, whereas only 22 percent of those that did not help others stayed sober.

A subsequent study by Dr. Pagano and her colleagues in 2009, also involving data from Project MATCH, showed that 94 percent of alcoholics who helped other alcoholics, at any point during the 15-month study, continued to do so as part of their ongoing recovery, and experienced lower levels of depression.

Positive Effects of Helping Others


Similarly, a study of alcoholic patients with body dysmorphic disorder (BDD), a condition in which a person is excessively preoccupied with a perceived physical defect, found that those who helped others were more likely to become sober and enjoy an improved self-image than non-helpers.

“These studies indicate that among alcoholics, AA-related helping and giving general help to others has positive effects on drinking outcomes and mental health variables,” Dr. Pagano says in the journal. In fact, the benefits of doing good works and helping others also extend to individuals coping with chronic conditions like depression, AIDS, and chronic pain.

Benefits to Society


“When humans help others regardless of a shared condition, they appear to live longer and happier lives,” she adds. The benefits of helping are significant because the costs of alcoholism and drug addiction to society are so great, Dr. Pagano says.

In light of recent health care reform, resources which can reduce these costs and suffering are crucial. However, the lack of consensus on what peer helping is in addiction recovery requires additional study to clarify what specific behaviors to encourage, to whom and what forms of service to recommend for individuals engaging in early and ongoing recovery.

Dr. Pagano is presently conducting a longitudinal study examining the role of service in adolescent addiction recovery. An area of new scientific discovery, she’s applying the knowledge she’s accrued with adults to adolescent populations with addition.

Posted by Webmaster at 11:31 AM


Spirituality of A.A. Is Effective

Addictions, whether it is to drugs or alcohol, are a very difficult hurdle for individuals to overcome. But, there are ways to help people with their recovery through 12-step programs like Alcoholics Anonymous (AA). Many of these organizations, including AA, highlight spirituality as a very important factor, but the data surrounding its effectiveness have often been contested.

However, research shows that as attendance of AA meetings increase, so do the participants spiritual beliefs, especially in those individuals who had low spirituality at the beginning of the study.

Important Aspect of Recovery

John F. Kelly, lead author of the study, Associate Professor in Psychiatry at Harvard Medical School and the Associate Director of the Center for Addiction Medicine at Massachusetts General Hospital, said that while spirituality is an important aspect of AA recovery, it is not the only way they can help individuals.

"I've heard it said that AA is too spiritual, and I've also heard it said that AA is not spiritual enough for some people. Although this is not the only way that AA helps individuals recover, I think these findings support the notion that AA works in part by enhancing spiritual practices," Kelly said.

The researchers assessed more than 1,500 adults throughout their recovery process, with data being gathered at three, six, nine, 12, and 15 months. The study utilized data on their attendance to AA meetings, their individual spirituality/religiosity practices and overall alcohol-use outcomes to determine if spirituality is indeed a mechanism of behavior change.

Decrease in Alcohol Use

The results indicated that there was a robust association between an increase in attendance to AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use over time. One of the most interesting aspects of the research was that the same amount of recovery was seen in both agnostics and atheists, which indicates that while spirituality is an important mechanism of behavioral change for AA, it is not the only method used.

"Many people will be surprised that alcoholic patients with little or no interest in spirituality attended AA and seemed to change even more than did those who had a pre-existing, strong sense of spirituality," said Keith Humphreys, a Career Research Scientist with the Veterans Health Administration and Professor of Psychiatry at Stanford University. "AA is thus much more broad in its appeal than is commonly recognized."

The researchers also noted that while spirituality is an important aspect of recovery, it is still not known how these beliefs work in complement or competition with other recovery methods, as there are multiple.

Changing Social Networks

"We have also found that AA participation leads to recovery by helping members change their social network and by enhancing individuals' recovery coping skills, motivation for continued abstinence, and by reducing depression and increasing psychological well-being," said Kelly.

"Down the road it will be important to conduct more qualitative research as well as further quantitative replication of our findings in order to understand more about how exactly spiritual practices and beliefs influence coping and behavioral change in recovery from addiction"

Posted by Webmaster at 11:28 AM


Stigma Deters Alcoholics From Seeking Treatment

Despite the existence of effective programs for treating alcohol dependencies and disorders, less than a quarter of people who are diagnosed actually seek treatment. In a study by Columbia University's Mailman School of Public Health researchers report that people diagnosed with alcoholism at some point in their lifetime were more than 60% less likely to seek treatment if they believed they would be stigmatized once their status is known.

This is the first study to address the underuse of alcohol services specifically with regard to alcohol-related stigma. Findings are published in the November issue of the American Journal of Epidemiology.

Perceived Negative Stigma

Based on a survey of 34,653 individuals in the general population (6,309 of whom had an alcohol use disorder) drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), researchers found that individuals with an alcohol use disorder who perceived negative stigma were 0.37 times less likely to seek treatment for their disorder compared to individuals with similarly serious alcohol disorders who did not perceive stigma.

In the general population, younger individuals perceived less stigma, and also were less likely to seek treatment for an alcohol disorder. Men perceived more stigma compared to women (38.1%vs. 37.7%). Non-Hispanic blacks and Hispanic adults overall reported a higher mean stigma compared to Whites (39 % vs. 37%) and were less likely to utilize alcohol services. However, the data also suggest that individuals with more severe alcohol disorders had a greater likelihood to seek treatment. Overall, perceived stigma was significantly higher for those with lower personal income, lower education, and individuals previously married compared to those who had never married.

A Barrier to Treatment

"People with alcohol disorders who perceive high levels of alcohol stigma may avoid entering treatment because it confirms their membership in a stigmatized group," said Katherine Keyes, PhD, in the Mailman School of Public Health Department Epidemiology. "Given that alcohol use disorders are one of the most prevalent psychiatric disorders in the United States, the empirical documentation of stigma as a barrier to treatment is an important public health finding. Greater attention to reducing the stigma of having an alcohol disorder is urgently needed so that more individuals access the effective systems of care available to treat these disabling conditions."

Posted by Webmaster at 11:24 AM


Energy Drink Use May Lead to Alcohol Dependence

Research indicates that individuals who have a high frequency of energy drink consumption (52 or more times within a year) were at a statistically significant higher risk for alcohol dependence and episodes of heavy drinking.

A hallmark of college life is staying up late to study for an exam the following morning, and many students stay awake by consuming an energy drink. Also increasing in popularity is the practice of mixing alcohol with energy drinks. But these drinks are highly caffeinated and can lead to other problems, in addition to losing sleep. Unfortunately, the contents of energy drinks are not regulated.

The results were published in the journal Alcoholism: Clinical & Experimental Research.

Energy Drinks Without Alcohol

Amelia M. Arria, the lead author of the study, Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health, and a Senior Scientist at the Treatment Research Institute, said that prior research has highlighted the dangers of combining energy drinks with alcohol.

"We were able to examine if energy drink use was still associated with alcohol dependence, after controlling for risk-taking characteristics. The relationship persisted and the use of energy drinks was found to be associated with an increase in the risk of alcohol dependence."

The study utilized data from more than 1,000 students enrolled at a public university who were asked about their consumption of energy drinks and their alcohol drinking behaviors within the past 12 months.

More Likely to Become Dependent

The researchers found that individuals who consumed energy drinks at a high frequency were more likely to get drunk at an earlier age, drink more per drinking session, and were more likely to develop alcohol dependence compared to both non-users of energy drinks and the low-frequency users.

The results of this study confirm and extend earlier research about the risks of energy drink consumption. A major concern is that mixing energy drinks with alcohol can lead to "wide-awake drunkenness," where caffeine masks the feeling of drunkenness but does not decrease actual alcohol-related impairment. As a result, the individual feels less drunk than they really are, which could lead them to consume even more alcohol or engage in risky activities like drunk driving.

Caffeine Disguises Impairment

"Caffeine does not antagonize or cancel out the impairment associated with drunkenness—it merely disguises the more obvious markers of that impairment," says Kathleen Miller, a research scientist from the Research Institute on Addictions at the University at Buffalo. According to her, the next steps in this research include identifying links between energy drinks and other forms of substance abuse, as well assessing the overall prevalence of energy drink use by adolescents and young adults.

"Also needed is research that directly assesses students' reported reasons for mixing alcohol and energy drinks. Anecdotal reports suggest that part of this phenomenon may be driven by the perpetuation of myths (e.g., mixing alcohol and caffeine reduces drunkenness, prevents hangovers, or fools a breathalyzer test) that could be debunked through further education."

Arria agrees, adding that further research and regulations are needed to curb this disturbing trend.

"The fact that there is no regulation on the amount of caffeine in energy drinks or no requirements related to the labeling of contents or possible health risks is concerning."

Posted by Webmaster at 11:18 AM


College Campus-Community Interventions Successful

The Safer California Universities study found that the program reduced incidence and likelihood of intoxication at off-campus parties and bars/restaurants. Heavy drinking among college students results in over 1800 deaths each year, as well as 590,000 unintentional injuries, almost 700,000 assaults and more than 97,000 victims of sexual assaults. In a study published in the American Journal of Preventive Medicine, researchers report on the results of the Safer California Universities study, a successful community-wide prevention strategy targeted at off-campus settings.

This is one of the first studies to focus on the total environment rather than on prevention aimed at individuals.

Reducing Off-Campus Drinking

The authors found significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants for Safer intervention universities. Students from Safer universities were 6% less likely to drink to intoxication during the last time they were at any of the targeted settings, 9% for off-campus parties, and 15% for bars/restaurants.

There was also evidence that drinking was reduced at fraternities and sororities. These declines were equivalent to 6,000 fewer incidents of intoxication at off-campus parties and 4,000 fewer incidents at bars & restaurants during the fall semester at each intervention schools relative to controls. Furthermore, stronger intervention effects were achieved at Safer universities with the highest level of implementation.

"These findings should give college administrators some degree of optimism that student drinking is amenable to a combination of well-chosen, evidence-based universal prevention strategies," commented lead investigator Robert F. Saltz, PhD, Pacific Institute for Research and Evaluation (PIRE), Berkeley, CA. "Here, one set of alcohol control strategies was found to be efficacious, but other combinations may work as well, or even better. With a growing body of such evidence, and combined with strategies already shown to be effective, it will be possible to craft a comprehensive prevention program that ratchets down the harm currently produced by alcohol use on and near college campuses."

Off-Campus Consumption

The Safer California Universities study involved 8 campuses of the University of California and 6 campuses in the California State University system. Half of these schools were randomly assigned to the Safer intervention, which took place in the fall semesters of 2005 and 2006.

Student surveys were completed by undergraduates in four fall semesters (2003 through 2006) and random samples of 1,000 to 2,000 students per campus per year were analyzed. Students were asked about where they drank, whether they had gotten drunk, and whether they had engaged in so-called "binge drinking." They were also questioned about their grade point averages and their general health, as well as other sociodemographic characteristics.

Safer environmental interventions included nuisance party enforcement operations, minor decoy operations, DUI checkpoints, social host ordinances, and use of campus and local media to increase the visibility of environmental strategies. Intervention campuses differed in their level of implementation, but all concentrated on off-campus activities for drinking.

Posted by Webmaster at 11:12 AM


Alcohol Damages Much More Than the Liver

Alcohol does much more harm to the body than just damaging the liver. Drinking also can weaken the immune system, slow healing, impair bone formation, increase the risk of HIV transmission and hinder recovery from burns, trauma, bleeding and surgery.

Researchers released the latest findings on such negative effects of alcohol during a meeting of the Alcohol and Immunology Research Interest Group, held at Loyola University Medical Center.

The Effects of Alcohol

At Loyola, about 50 faculty members, technicians, post-doctoral fellows and students are conducting alcohol research. Studies at Loyola and other centers could lead to therapies to boost the immune system or otherwise minimize the effects of alcohol, said Elizabeth J. Kovacs, PhD, director of Loyola's Alcohol Research Program and associate director of Loyola's Burn & Shock Trauma Institute.

"Of course, the best way to prevent the damaging effects of alcohol is to not drink in the first place," Kovacs said. "But it is very difficult to get people to do this."

Sessions at the conference included Alcohol and Infection, Alcohol and Oxidative Stress and Alcohol and Organ Inflammation. Findings were presented by researchers from centers around the country, including Loyola, Cleveland Clinic, University of Iowa, University of Colorado, University of Massachusetts, Mississippi State University, Chicago State University and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Posted by Webmaster at 11:06 AM


Heavy Smoking Doubles Alzheimer's Risk

Heavy smoking in midlife is associated with a 157 percent increased risk of developing Alzheimer's disease and a 172 percent increased risk of developing vascular dementia, according to a Kaiser Permanente study published in the Archives of Internal Medicine. This is the first study to look at the long-term consequences of heavy smoking on dementia.

Increased Risk Among Smokers

Researchers followed an ethnically diverse population of 21,123 men and women from midlife onward for an average of 23 years. Compared with non-smokers, those who had smoked more than two packs of cigarettes a day had more than a 157 percent increased in risk of Alzheimer's disease and 172 percent increased risk of vascular dementia during the mean follow-up period of 23 years. Vascular dementia, the second most common form of dementia after Alzheimer's disease, is a group of dementia syndromes caused by conditions affecting the blood supply to the brain.

"This study shows that the brain is not immune to the long-term consequences of heavy smoking," said the study's principal investigator, Rachel A. Whitmer, Ph.D., a research scientist with the Kaiser Permanente Division of Research in Oakland, Calif. "We know smoking compromises the vascular system by affecting blood pressure and elevates blood clotting factors, and we know vascular health plays a role in risk of Alzheimer's disease."

Researchers analyzed prospective data from of 21,123 Kaiser Permanente Northern California members who participated in a survey between 1978 and 1985. Diagnoses of dementia, Alzheimer's disease and vascular dementia made in internal medicine, neurology, and neuropsychology were collected from 1994 to 2008. The researchers adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use.

Brain Vessels Affected

"While we don't know for sure, we think the mechanisms between smoking and Alzheimer's and vascular dementia are complex, including possible deleterious effects to brain blood vessels as well as brain cells," said study co-author Minna Rusanen, MD, of the University of Eastern Finland and Kuopio University Hospital in Finland.

This study is the latest in a series of published Kaiser Permanente research to better understand the modifiable risk factors for dementia. This ongoing body of research adds to evidence base that what is good for the heart is good for the brain, and that midlife is not too soon to begin preventing dementia with good health.

The other studies led by Whitmer found that a large abdomen in midlife increases risk of late-life dementia, elevated cholesterol levels in midlife increase risk of Alzheimer's disease and vascular dementia, and low blood-sugar events in elderly patients with type 2 diabetes increase dementia risk. Another Kaiser Permanente study led by Valerie Crooks of Kaiser Permanente in Southern California found that having a strong social network of friends and family appears to decrease risk for dementia.

Increased Risk Among Smokers

Researchers followed an ethnically diverse population of 21,123 men and women from midlife onward for an average of 23 years. Compared with non-smokers, those who had smoked more than two packs of cigarettes a day had more than a 157 percent increased in risk of Alzheimer's disease and 172 percent increased risk of vascular dementia during the mean follow-up period of 23 years. Vascular dementia, the second most common form of dementia after Alzheimer's disease, is a group of dementia syndromes caused by conditions affecting the blood supply to the brain.

"This study shows that the brain is not immune to the long-term consequences of heavy smoking," said the study's principal investigator, Rachel A. Whitmer, Ph.D., a research scientist with the Kaiser Permanente Division of Research in Oakland, Calif. "We know smoking compromises the vascular system by affecting blood pressure and elevates blood clotting factors, and we know vascular health plays a role in risk of Alzheimer's disease."

Researchers analyzed prospective data from of 21,123 Kaiser Permanente Northern California members who participated in a survey between 1978 and 1985. Diagnoses of dementia, Alzheimer's disease and vascular dementia made in internal medicine, neurology, and neuropsychology were collected from 1994 to 2008. The researchers adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use.

Brain Vessels Affected

"While we don't know for sure, we think the mechanisms between smoking and Alzheimer's and vascular dementia are complex, including possible deleterious effects to brain blood vessels as well as brain cells," said study co-author Minna Rusanen, MD, of the University of Eastern Finland and Kuopio University Hospital in Finland.

This study is the latest in a series of published Kaiser Permanente research to better understand the modifiable risk factors for dementia. This ongoing body of research adds to evidence base that what is good for the heart is good for the brain, and that midlife is not too soon to begin preventing dementia with good health. The other studies led by Whitmer found that a large abdomen in midlife increases risk of late-life dementia, elevated cholesterol levels in midlife increase risk of Alzheimer's disease and vascular dementia, and low blood-sugar events in elderly patients with type 2 diabetes increase dementia risk. Another Kaiser Permanente study led by Valerie Crooks of Kaiser Permanente in Southern California found that having a strong social network of friends and family appears to decrease risk for dementia.

Posted by Webmaster at 10:57 AM


Alcohol Ups Risk of Breast Cancer Recurrence

A study of early-stage breast cancer patients who were light drinkers found an increased risk for recurrence of breast cancer and mortality. In the Life After Cancer Epidemiology (LACE) study, 1,897 participants diagnosed with early-stage breast cancer between 1997 and 2000 and recruited on average 2 years post-breast cancer diagnosis were evaluated for the association between alcohol intake and breast cancer recurrence and death.

The women, who were generally light drinkers, were followed for an average of 7.4 years. The study reported an increase in risk of breast cancer recurrence and breast cancer death, but no effect on total mortality, to be associated with consumption of 3 to 4 or more drinks per week when compared with women not drinking following their cancer diagnosis.

Alcohol and Breast Cancer

Previous research has been mixed on this topic. Almost all large studies have shown no increase in all-cause mortality for women who drink moderately following a diagnosis of breast cancer (as does this study).

As for recurrence of breast cancer, most have shown no increase in risk, although one previous study of women with estrogen-receptor + tumors found an increased risk of a primary cancer developing in the contralateral breast to be associated with alcohol intake of more than 7 drinks per week.

Because of conflicting results among studies on this topic, further research will be needed to determine the extent to which alcohol following a diagnosis of breast cancer may relate to subsequent disease and death.

Posted by Webmaster at 10:53 AM


Stress Hormone Impacts Alcohol Recovery

Scientists at the University of Liverpool have found that high levels of a stress hormone in recovering alcoholics could increase the risk of relapse. The study showed that cortisol, a hormone produced by the adrenal gland in response to stress, is found in high levels in chronic alcoholics, as well as those recovering from the condition. Researchers found that this could result in impaired memory, attention and decision-making functions, which could decrease the patient's ability to engage with treatment.

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

Cortisol and Recovery

Cortisol plays an important role in the regulation of emotion, learning, attention, energy utilization, and the immune system. The research showed that high levels of this hormone are present in alcoholic patients and continue to be elevated during withdrawal from alcohol and after long periods of abstinence.

Dr Abi Rose (lead author of the review), in the School of Psychology, Health and Society at the University of Liverpool, said: "Both drinking and withdrawal from alcohol can affect cortisol function in humans. Cortisol dysfunction, including the high levels of cortisol observed during alcohol withdrawal, may contribute to the high rates of relapse reported in alcohol dependence, even after many months of abstinence. Drugs targeting the effects of cortisol in the brain might reduce the chances of relapse and reduce the cognitive impairments that interfere with treatment."

Posted by Webmaster at 10:47 AM


Just 2 Drinks Can Impair Older Drinkers

Blood alcohol levels below the current legal limit for driving have a significant negative effect on a person's dexterity. Researchers writing in the open access journal BMC Research Notes found that just two single vodka and orange drinks were enough to make senior volunteers struggle at an obstacle avoidance test while walking.

Judith Hegeman worked with a team of researchers from Sint Maartenskliniek, Nijmegen, The Netherlands, to carry out the tests in 13 healthy men and women (average age 61.5yrs or 62yrs). She said, "The results clearly show that even with low blood alcohol concentrations, reactions to sudden gait perturbations are seriously affected. After ingestion of 2 alcoholic drinks, obstacles were hit twice as often, response times were delayed and response amplitudes were reduced. These changes were most obvious in situations with little available response time."

Alcohol Hampers Reaction Times

To carry out the test, the volunteers first started to walk on a treadmill. Once they had attained a steady walking pace, a thin wooden block was placed at the far end of the belt and allowed to move towards the volunteer. Hegeman and her colleagues measured the effects of alcohol on how capable the subjects were of stepping over this obstacle.

She said, "We found that alcohol levels, considered to be safe for driving, seriously hamper the ability to successfully avoid sudden obstacles in the travel path. A possible limitation of this study is the relatively small sample size, however even with the small number, it yielded an unequivocal outcome."

Posted by Webmaster at 10:43 AM


Alcoholic Liver Disease Becoming More Aggressive

Many diagnostic and treatment options have been developed for chronic liver disease during the last 40 years, yet their influence on survival remain unclear. A study of the prognosis for patients hospitalized for liver diseases between 1969 and 2006, and of differences in mortality and complications between patients with alcoholic and non-alcoholic liver diseases, has found that the general prognosis for patients hospitalized with chronic liver diseases has not improved.

"The most effective changes in treatment for chronic liver disease during the last 40 years are, in my opinion, combination treatment for hepatitis C and treatment with prednisolone and azathioprine for autoimmune hepatitis," said Knut Stokkeland, an instructor in the department of medicine at Visby Hospital in Sweden and corresponding author for the study. "In addition, new diagnostic tools such as endoscopic examinations, computed tomography, MRI, and ultrasound have probably increased our possibilities to detect early disease and the development of cirrhosis."

Alcohol Dependence Increases Risks

Stokkeland added that the key difference between alcoholic and non-alcoholic liver disease is alcohol dependence (AD), which almost all patients with alcoholic liver disease have. "AD increases the risks of social problems, being a smoker, and severe psychiatric diseases," he said. "It also inhibits staying sober, which may stop disease progression."

Stokkeland and his colleagues used data from the Swedish Hospital Discharge Register and Cause of Death Register between 1969 and 2006 to both identify and follow up with a cohort of 36,462 patients hospitalized with alcoholic liver diseases and 95,842 patients hospitalized with non-alcoholic liver diseases.

"The main finding of Dr. Stokkeland's study is the much increased mortality risk of having an alcohol- versus a non-alcohol-related liver disease," observed Johan Franck, a professor of clinical addiction research at Karolinska Institutet in Sweden. "Thus, patients with alcohol-induced liver diseases should receive more attention, and they should routinely be offered treatment for their alcohol-use disorder. Presumably, the various treatment systems involved – such as hepatology versus substance-abuse care – may not be very well coordinated and this may present an area for improvement."

Must Focus on Treating Alcoholism

Stokkeland agreed. "This may be caused by the fact that hospitalized patients with [alcoholic] liver disease have such a severe liver disease that no effort may change their prognosis," he said. "I hope this study will motivate clinicians and scientists in the field of hepatology and gastroenterology to design clinical studies to see if any changes in care-taking of our patients with alcoholic liver disease may change their severe prognosis. We must also focus on treating their AD so that they may stop drinking."

"Given that alcohol doubles the risk of having a serious liver disease," added Franck, "efforts to reduce alcohol drinking will likely have a positive impact on the disease's outcome."

Results were published in the journal Alcoholism: Clinical & Experimental Research.

Posted by Webmaster at 10:39 AM


Women Beer Drinkers Likely to Develop Psoriasis

Regular beer—but not light beer or other types of alcohol—appears to be associated with an increased risk of developing psoriasis, according to a report posted online that will be published in the Archives of Dermatology.

"Psoriasis is a common immune-mediated skin disease," the authors write as background information in the article. "The association between alcohol consumption and increased risk of psoriasis onset and psoriasis worsening has long been suspected. For example, individuals with psoriasis drink more alcohol than individuals without psoriasis, and alcohol intake may exacerbate psoriasis severity."

Alcohol and Psoriasis

For other diseases, type of alcoholic beverage has been shown to influence risk—for instance, beer confers a larger risk for gout than wine or spirits. To evaluate the association between different types of alcohol and psoriasis risk, Abrar A. Qureshi, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, assessed data from 82,869 women who were age 27 to 44 years in 1991. The women, participants in the Nurses' Health Study II, reported the amount and type of alcohol they consumed on biennial questionnaires. They also reported whether they had received a diagnosis of psoriasis.

Through 2005, 1,150 cases of psoriasis developed, 1,069 of which were used for analysis. Compared with women who did not drink alcohol, the risk of psoriasis was 72 percent greater among women who had an average of 2.3 drinks per week or more. When beverages were assessed by type, there was an association between non-light beer drinking and psoriasis, such that women who drank five or more beers per week had a risk for the condition that was 1.8 times higher. Light beer, red wine, white wine and liquor were not associated with psoriasis risk.

When only confirmed psoriasis cases—those in which women provided more details about their condition on a seven-item self-assessment—were considered, the risk for psoriasis was 2.3 times higher for women who drank five or more beers per week than women who did not drink beer.

Increased Risk of Psoriasis

"Non-light beer was the only alcoholic beverage that increased the risk for psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new-onset psoriasis," the authors write. "One of these components may be the starch source used in making beer. Beer is one of the few non-distilled alcoholic beverages that use a starch source for fermentation, which is commonly barley." Barley and other starches contain gluten, to which some individuals with psoriasis show a sensitivity. Lower amounts of grain are used to make light beer as compared with non-light beer, potentially explaining why light beer was not associated with psoriasis risk, they note.

"Women with a high risk of psoriasis may consider avoiding higher intake of non-light beer," the authors conclude. "We suggest conducting further investigations into the potential mechanisms of non-light beer inducing new-onset psoriasis."

Posted by Webmaster at 10:31 AM


ER Teen Pep Talk Can Reduce Drinking, Violence

A brief, motivational talk in the emergency room reduced by half the chances that teenagers would experience peer violence or problems due to drinking, according to a study published in a theme issue of the Journal of the American Medical Association. The special issue on violence and human rights includes the work of University of Michigan Health System researchers who immersed themselves at the Hurley Medical Center emergency department, in Flint, Mich., for three years.

Researchers offered help to 726 adolescents, ages 14-18, who reported they experienced aggression or had a drink of beer, wine or liquor at least two or three times in the past year.

Reduction in Aggression


A one-on-one talk with a therapist resulted in a 34 percent reduction in peer aggression. Teens who received only a brochure had a 16 percent drop in aggression over the next three months.

The study showed similar drops in alcohol misuse after teens heard prevention messages delivered by a therapist or while using a role-playing computer program.

"Violence and alcohol use are preventable behaviors and the emergency department can be a key location for reaching high-risk teenagers," says senior author Rebecca Cunningham, M.D., an emergency room physician and director of the University of Michigan Injury Research Center.

Violence and injuries are the leading causes of deaths among adolescents in the United States and the incidents are often fueled by alcohol. The U-M study showed ED interventions can also reduce alcohol-related problems by as much as 32 percent for six months.

The talks with teens were more complex than a parent talking to a child about the dangers of drinking and how to avoid peer pressure.

"Therapists used motivational interviewing which is well-suited for adolescent development," says study lead author Maureen Walton, M.P.H., Ph.D., research associate professor in the U-M Department of Psychiatry, Addiction Research Center. "It doesn’t preach or tell teens what to do, but allows adolescents to weigh the pros and cons of their choices in reference to their goals."

The therapists’ talks with teens also included role play exercises and tools to cope with risky situations that involve drinking or violence and referrals to community services.

Motivational Interviewing


"Most of the adolescents had high aspirations – they wanted to go to college, be a good role model for their younger siblings. They didn’t want to make the mistakes they saw happening around them," Walton explains. "We talked to them about the discrepancies between their behavior and what they wanted to do with their lives."

Motivational Interviewing, with proper training, can be used effectively by healthcare providers as well those without a professional healthcare background. Study co-author Stephen T. Chermack, Ph.D, a clinical psychologist and addiction specialist at the U-M Health System and the VA Healthcare System in Ann Arbor, is a member of the Motivational Interviewing Network of Trainers (MINT).

Adolescents in the study reported to the emergency department at Hurley Medical Center between noon and 11 p.m., during the three-year period, September 2006 to September 2009.

All patients completed computerized screening questions regarding alcohol use and violence and were randomized into three groups: a control group receiving a brochure, or one of two groups receiving a 35-minute brief intervention delivered by a computer or a therapist in the emergency room.

Authors say the computer screening worked well with teenagers because of their comfort with using technology. The computer program included animated role playing such as how to handle drinking and driving and conflicts with peers.

High-Risk Youth in the ER


"The study tells us that technology can aid in assisting high-risk youth in busy clinical settings, as well as deliver important prevention messages," says Cunningham who is also an associate professor of emergency medicine at the U-M Medical School and associate professor of health behavior & health education at the U-M School of Public Health. "Emergency staff are busy and not all hospitals have the resource of a social worker or therapist present at all times in the emergency department."

The ED can be a prime location for reaching high-risk teenagers since many may skip school, consider themselves too old to go to a pediatrician, yet often do not have a primary care doctor.

"We see the consequences our patients face from violence," says Cunningham who is part of the team of U-M physicians who work in the Flint emergency department.

"But in addition to treating the immediate wounds from violence, the emergency department can offer opportunities to help the teens we see prevent future problems with alcohol and violence."

Posted by Webmaster at 10:29 AM


Child Abuse: Malicious Use of Pharmaceuticals

Child abuse is a serious problem that affects nearly one million children a year in the United States alone. The American Academy of Pediatrics and the US Department of Health and Human Services classify child abuse into four categories including neglect, physical abuse, sexual abuse, and emotional abuse. None of these categories, however, clearly includes the abusive use of drugs on children. A study published in the Journal of Pediatrics investigates the malicious use of pharmaceuticals and attempts to shed light on this under-recognized problem.

Dr. Shan Yin from the University of Colorado and the Rocky Mountain Poison Drug Center at Denver Health reviewed cases of pharmaceutical abuse reported to the National Poison Data System between 2000 and 2008. Dr. Yin included reports of the malicious use of alcohol, painkillers, cough and cold medicines, sedatives and sleeping pills, and antipsychotic medicines.

Using Drugs to Subdue Children

Of the more than 1400 cases studied, nearly 14% resulted in moderate to major consequences, including death. Nearly one-half of the abused children were exposed to at least one sedative. An average of 160 cases, including two deaths, was reported each year. Motives and legal findings were unavailable for these particular cases; however, motives for the abusive use of drugs generally are varied, and can include punishment, amusement, or a wish for a break from childcare responsibilities.

This study illustrates the seriousness of the abusive use of drugs administered to children. According to Dr. Yin, "The malicious administration of pharmaceuticals should be considered an important form of child abuse." He encourages pediatricians and emergency medical personnel to be on the watch for this form of maltreatment, and suggests the use of comprehensive drug screening during the evaluation of a child suspected to be the victim of abuse. Dr. Yin also cautions parents that the "non-therapeutic administration of pharmaceuticals to children can result in serious outcomes, including death."

Posted by Webmaster at 10:26 AM


Parenting Style Can Prevent Binge Drinking

Parents may be surprised, even disappointed, to find out they don’t influence whether their teen tries alcohol. But now for some good news: Parenting style strongly and directly affects teens when it comes to heavy drinking – defined as having five or more drinks in a row – according to a new Brigham Young University study.

The researchers surveyed nearly 5,000 adolescents between the ages of 12 and 19 about their drinking habits and their relationship with their parents. Specifically, they examined parents’ levels of accountability – knowing where they spend their time and with whom – and the warmth they share with their kids.

Less Likely to Binge Drink

Here’s what they found:

  • The teens least prone to heavy drinking had parents who scored high on both accountability and warmth.

  • So-called “indulgent” parents, those low on accountability and high on warmth, nearly tripled the risk of their teen participating in heavy drinking.

  • “Strict” parents – high on accountability and low on warmth – more than doubled their teen’s risk of heavy drinking.

Prior research on parenting style and teen drinking was a mixed bag, showing modest influence at best. Unlike previous research, this study distinguished between any alcohol consumption and heavy drinking.

“While parents didn’t have much of an effect on whether their teens tried alcohol, they can have a significant impact on the more dangerous type of drinking,” said Stephen Bahr, a professor in BYU’s College of Family, Home and Social Sciences.

Bahr, along with co-author John Hoffmann, will publish the study in the July issue of the Journal of Studies on Alcohol and Drugs.

The statistical analysis also showed that religious teens were significantly less likely to drink any alcohol. The effect of religiosity mirrors findings from this 2008 study Bahr and Hoffmann conducted on teens' marijuana use.

Non-Drinking Friends

Not surprisingly, a teen’s peers play an important role on whether a teen drinks. The BYU researchers note that teens in this new study were more likely to have non-drinking friends if their parents scored high on warmth and accountability.

“The adolescent period is kind of a transitional period and parents sometimes have a hard time navigating that,” Bahr said. “Although peers are very important, it’s not true that parents have no influence.”

For parents, the takeaway is this:

“Realize you need to have both accountability and support in your relationship with your adolescent,” Hoffmann said. “Make sure that it’s not just about controlling their behavior – you need to combine knowing how they spend their time away from home with a warm, loving relationship.”

Posted by Webmaster at 10:20 AM


Addiction: a Loss of Plasticity of the Brain?

Why is it that only some drug users become addicts? This is the question that has been addressed by the teams of Pier Vincenzo Piazza and Olivier Manzoni, at the Neurocentre Magendie in Bordeaux (Inserm unit 862). These researchers have discovered that the transition to addiction could result from a persistent impairment of synaptic plasticity in a key structure of the brain. This is the first demonstration that a correlation exists between synaptic plasticity and the transition to addiction.

The results from the teams at Neurocentre Magendie call into question the hitherto held idea that addiction results from pathological cerebral modifications which develop gradually with drug usage. Their results show that addiction may, instead, come from a form of anaplasticity, i.e. from incapacity of addicted individuals to counteract the pathological modifications caused by the drug to all users.

This research is published in the journal Science.

Developing Drug Addiction

The voluntary consumption of drugs is a behaviour found in many species of animal. However, it had long been considered that addiction, defined as compulsive and pathological drug consumption, is a behaviour specific to the human species and its social structure. In 2004, the team of Pier Vincenzo Piazza showed that the behaviours which define addiction in humans, also appear in some rats which will self administer cocaine. Addiction exhibits astonishing similarities in men and rodents, in particular the fact that only a small number of consumers (humans or rodents) develop a drug addiction. The study of drug dependent behaviour in this mammal model thus opened the way to the study of the biology of addiction.

Today, thanks to a fruitful collaboration, the teams of Pier Vincenzo Piazza and Olivier Manzoni are reporting discovery of the first known biological mechanisms for the transition from regular but controlled drug taking to a genuine addiction to cocaine, characterised by a loss of control over drug consumption.

Chronic exposure to drugs causes many modifications to the physiology of the brain. Which of these modifications is responsible for the development of an addiction? This is the question the researchers wanted to answer in order to target possible therapeutic approaches to a disorder for which treatments are cruelly lacking.

Some Become Addicted, Some Don't

The addiction model developed in Bordeaux provides a unique tool to answer this question. Thus it allows comparing animals who took identical quantities of drugs, but of which only few become addicted. By comparing addict and non-addict animals at various time points during their history of drug taking, the teams of Pier Vincenzo Piazza and Olivier Manzoni have demonstrated that the animals which developed an addiction to cocaine exhibit a permanent loss of the capacity to produce a form of plasticity known as long term depression (or LTD). LTD refers to the ability of the synapses (the region of communication between neurons) to reduce their activity under the effect of certain stimulations. It plays a major role in the ability to develop new memory traces and, consequently, to demonstrate flexible behaviour.

After short term usage of cocaine, LTD is not modified. However, after a longer use, a significant LTD deficit appears in all users. Without this form of plasticity, which allows new learning to occur, behaviour with regard to the drug becomes more and more rigid, opening the door to development of a compulsive consumption. The brain of the majority of users is able to produce the biological adaptations which allow to counteract the effects of the drug and to recover a normal LTD. By contrast, the anaplasticity (or lack of plasticity) exhibited by the addicts leaves them without defences and hence the LTD deficit provoked by the drug becomes chronic. This permanent absence of synaptic plasticity would explain why drug seeking behaviour becomes resistant to environmental constraints (difficulty in procuring the substance, adverse consequences of taking the drug on health, social life, etc.) and consequently more and more compulsive. Gradually, control of the taking of the drug is lost and addiction appears.

New Treatment for Addiction?

For Pier-Vincenzo Piazza and his collaborators, these discoveries also have important implications for developing new treatment of addiction. "We are probably not going to find new therapies by trying to understand the modifications caused by a drug in the brains of drug addicts," explain the researchers, "since their brain is anaplastic."

For the authors, "The results of this work show that it is in the brain of the non-addicted users that we will probably find the key to a true addiction therapy. Indeed," the authors estimate, "understanding the biological mechanisms which enable adaptation to the drug and which help the user to maintain a controlled consumption could provide us with the tools to combat the anaplastic state that leads to addiction".

Posted by Webmaster at 10:17 AM


Ignoring Stress Leads to Drug Cravings

Recovering addicts who avoid coping with stress succumb easily to substance use cravings, making them more likely to relapse during recovery, according to behavioral researchers. "Cravings are a strong predictor of relapse," said H. Harrington Cleveland, associate professor of human development, Penn State. "The goal of this study is to predict the variation in substance craving in a person on a within-day basis. Because recovery must be maintained 'one day at a time,' researchers have to understand it on the same daily level."

Craving Triggers

Cleveland and his colleague Kitty S. Harris, director, Center for the Study of Addiction and Recovery, Texas Tech University, used data from a daily diary study of college students who are recovering addicts to identify the processes that trigger cravings and prevent some addicts from building a sustained recovery.

The researchers found that how addicts cope with stress -- either by working through a problem or avoiding it -- is a strong predictor of whether they will experience cravings when faced with stress and negative mood.

Coping Skills Important

"Whether you avoid problems or analyze problems not only makes a big difference in your life but also has a powerful impact on someone who has worked hard to stay away from alcohol and other drugs," explained Cleveland. "When faced with stress, addicts who have more adaptive coping skills appear to have a better chance of staying in recovery." The findings appeared in a recent issue of Addictive Behaviors.

Researchers supplied Palm Pilots to 55 college students who were in recovery from substance abuse ranging from alcohol to cocaine and club drugs. The students were asked to record the their daily cravings for alcohol and other drugs, as well as the intensity of negative social experiences -- hostility, insensitivity, interference, and ridicule -- and their general strategies for coping with stress.

"We looked at variations in the number of cravings across days and found that these variations are predicted by stressful experiences," said Cleveland. "More importantly, we found that the strength of the daily link between experiencing stress and the level of cravings experienced is related to the participants' reliance on avoidance coping."

Stress Doubles Cravings

Statistical analyses of the survey data suggests that the magnitude of the link between having a stressful day and experiencing substance use cravings doubles for recovering addicts who cope with stress by avoiding it.

"We found that addicts who deal with stress by avoiding it have twice the number of cravings in a stressful day compared to persons who use problem solving strategies to understand and deal with the stress," explained Cleveland. "Avoidance coping appears to undercut a person's ability to deal with stress and exposes that person to variations in craving that could impact recovery from addiction."

According to Cleveland, the findings suggest the impulse to avoid stress is never going to help recovering addicts because stressful experiences cannot be avoided.

"If your basic life strategy is to avoid stress, then your problems will probably end up multiplying and causing you more problems," he added.

Posted by Webmaster at 10:13 AM


Peer Drug Use Increases Genetic Tendency to Use

The nature-nurture debate is usually about how much of something is due to our genes and how much is caused by our environment. New research just published in the academic journal Addiction shows that the case is more interesting for young women who smoke, drink, or use drugs, for two related reasons.

First, a young woman with a genetic predisposition to substance use is also predisposed to choose friends who smoke, drink, or use drugs, thereby altering her environment in a way that encourages substance use. Second, a young woman's exposure to substance-using friends not only changes her environment but also increases her genetic inclination to use these drugs regularly, thereby raising even higher her already increased likelihood of substance use.

Friends Influence Substance Abuse

Using a sample of over 2,000 female twins, researchers from Washington University in St. Louis looked for links between two types of data: 1) women in the sample who regularly used tobacco, alcohol, or drugs and 2) women whose friends were involved in regular substance use. The links they found showed that genetic vulnerability to regular use of alcohol, cigarettes and cannabis is exacerbated by exposure to friends who use alcohol, cigarettes and drugs.

It is well known that adolescents often select peers who engage in behaviors similar to their own. But this study showed that peer selection has a genetic basis whereby one's genetic predisposition to regular substance use is correlated with the likelihood of choosing friends who also use psychoactive substances. The genetic factors that influence our own likelihood of using drugs thus also modify our likelihood of associating with friends who do the same.

Interited Factors

However, exposure to these drug-using peers has a second, important influence on our own liability to use drugs. The study found that heritable influences on an individual's own regular substance use increased as they affiliated with more drug-using peers – in other words, affiliations with substance-using peers enhances the role that heritable factors play in our own regular substance use. Put simply, increasing affiliations with drug-using peers is correlated with a more 'genetic' form of regular substance use.

According to lead author Dr. Arpana Agrawal, "Nature and nurture don't just combine to produce a woman who smokes, drinks, or uses drugs – nurture can also increase the effect of nature."

Posted by Webmaster at 10:10 AM


Naltrexone Reduces Brain's Response to Craving

Researchers at Harvard-affiliated McLean Hospital have produced the first evidence that the opioid blocker extended-release injectable naltrexone (XR-NTX) is able to reduce the brain's response to cues that may cause alcoholics to relapse. In data presented at the annual meeting of the American Psychiatric Association, Scott Lukas, PhD, director of the Neuroimaging Center at McLean, located in Belmont, Mass., said the findings help in the understanding of how XR-NTX works in reducing the craving for alcohol and may potentially help predict which people will respond best to the drug.

Less Likely to Relapse

"These data are quite important since relapse remains a significant challenge in treating patients with alcohol dependence," Lukas said. "It looks to us that XR-NTX can help people remain abstinent by reducing the importance of these cues so they are less likely to relapse."

XR-NTX works by blocking opioid receptors in the brain and was approved for the treatment of alcohol dependence in 2006. XR-NTX is commercially available as Vivitrol®.

Reducing Alcohol Consumption

"We were trying to better understand the biological basis of how XR-NTX reduces alcohol consumption," Lukas said. "These data clearly demonstrate that XR-NTX reduced craving response in the brain when patients were presented with alcohol cues."

In the study, which has not yet been published, the researchers used brain imaging as a tool to document how XR-NTX works when a person is placed in a situation deemed risky for alcohol relapse.

A total of 28 alcohol-dependent individuals were tested with a BOLD (Blood Oxygen Level Dependent) fMRI scan while shown pictures of bottles or glasses of alcoholic beverages and exposed to odors of their particular alcoholic beverage of choice.

Testing Naltrexone Injections

Under double-blind conditions, fifteen of the subjects were given an injection of a XR-NTX and thirteen subjects were given a placebo injection. The study did not test the older form of naltrexone, which is taken daily in pill form.

Initially, the subjects were asked to self-report their cravings for alcohol after being exposed to the alcohol cues. All subjects reported that their cravings increased in the first few minutes after exposure to the cues.

Alcohol Cravings Diminished

However, those on XR-NTX reported that their cravings started to diminish after a few minutes, while those on placebo injection reported no such decrease in craving levels.

fMRI images also revealed that the pictures and odors induced sharply contrasting brain blood flow activation patterns. Scans were taken at baseline and again two weeks after the injection. Scans of subjects on placebo were virtually unchanged after two weeks. But those subjects on XR-NTX showed significant reductions in activation patterns in areas of the brain having to do with cognitive and emotional processing and reward circuitry on the second scan following exposure to the alcohol cues.

Responded Less to Alcohol Cues

"The areas in the brain associated with craving did not light up nearly as much in patients treated with XR-NTX compared to patients on placebo," Lukas said. "These data suggest that those patients on XR-NTX were responding less strongly to the alcohol cues after being on the drug for only two weeks," he added.

Lukas cautioned, "There is no single magic bullet, but having a choice of medications at our disposal gives physicians an increased chance to better treat a wide range of addictions."

Understanding cravings and how medication can play a role in controlling them will help to improve treatment for patients with alcohol dependence.

Posted by Webmaster at 09:55 AM


Smoking Bans Reduce Heart Attack Admissions

A nationwide smoking ban in public places would save more than $90 million and significantly reduce hospitalizations for heart attack, according to a Henry Ford Hospital study. After analyzing data from the 13 states that don't have a law banning smoking in public places, researchers concluded that more than 18,596 fewer hospitalizations for heart attack could be realized from a smoking ban in all 50 states after the first year of implementation, resulting in more than $92 million in savings in hospitals costs for caring for those patients.

The study, funded by the hospital, was at the American Heart Association's annual Quality of Care and Outcomes Research conference in Washington.

Smokers Harming Themselves

"Even if you just save one heart attack, it is something significant," says Mouaz Al-Mallah, M.D., Henry Ford's co-director of Cardiac Imaging Reearch and lead author of the study. "When people smoke, they are not only harming themselves, they're harming those around them who are exposed to secondhand smoke."

A similar study conducted in 2008 by Dr. Al-Mallah found that a smoking ban in Michigan could lead to a 12 percent drop in heart attack admissions after the first year of implementation. On May 1, Michigan became the 38th state to ban smoking in public places.

Heart Attack Rates Reduced

Prior research involving risk reduction from smoking bans has shown that heart attack rates can be reduced by 11 percent after a comprehensive smoking ban.

Henry Ford obtained 2007 data on the number of heart attack discharges, length of stay and hospital charges from the 13 states currently without a public smoking ban. Researchers found 169,043 hospitalizations for heart attack were reported in the states with a comprehensive smoking ban. When the same 11 percent risk reduction was applied to the non-smoking states, researchers concluded it would led to 18,596 fewer heart attack admissions.

Posted by Webmaster at 09:49 AM


Heavy Alcohol Use Hikes Risk of Pancreatic Cancer

Heavy alcohol use and binge drinking could increase the risk of pancreatic cancer in men, research from UT Southwestern Medical Center suggests. In a study available online in Cancer Causes and Control, researchers found that the more alcohol a man consumed, the higher his risk of pancreatic cancer compared with those who drank little or no alcohol.

Important to Reduce Drinking

"If this relationship continues to be confirmed, reducing heavy and binge drinking may be more important than we already know," said Dr. Samir Gupta, assistant professor of internal medicine at UT Southwestern and lead author of the study, which was conducted at the University of California, San Francisco.

Researchers found that men who consumed alcohol increased their risk of pancreatic cancer by 1.5 to 6 times compared with those who didn't consume alcohol or who had less than one drink per month. The increased risk depended on the amount and frequency of alcohol consumption. Researchers found that the risk was greater no matter when in the past heavy drinking occurred.

Binge Drinking a Risk Factor

They also found that men who engaged in binge drinking had a 3.5 times greater likelihood of developing pancreatic cancer. Their risk also was greater regardless of when the binge episodes occurred.

Researchers defined one drink as a can, bottle or 12 ounces of beer; a 4-ounce glass of wine; or one shot of liquor. Each of these servings contains about 14 grams of alcohol. The heaviest drinkers consumed 21 to 35 drinks per week. Binge drinking was defined as consuming five or more drinks during one drinking episode.

Researchers did not find the association among women, possibly due to the lower proportion of women who reported heavy or binge drinking, said Dr. Gupta, who also is affiliated with the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern.

Deadly Pancreatic Cancer

"Pancreatic cancer is one of the deadliest cancers, so any risk factor that can be identified and addressed may save lives," Dr. Gupta said. "Our research found that large and frequent amounts of alcohol consumption may be risk factors for pancreatic cancer."

Previous studies inconsistently have linked alcohol and pancreatic cancer. Dr. Gupta said his study is different, however, because the researchers collected more detailed information on alcohol consumption and binge drinking than other studies and because the researchers were able to analyze the data for multiple factors that previously hadn't been considered in great detail.

532 Cases Reviewed

In the current study, researchers used structured questionnaires to interview pancreatic cancer patients in the San Francisco area diagnosed between 1995 and 1999 and compared those results with those of control participants matched by sex, age and county of residence.

The 532 cancer patients ranged in age from 21 to 85, with the majority between 60 and 80 years of age. Fifty-five percent of study participants were men; 83 percent of them were Caucasian; and most of them were of normal weight with some college education. The 1,701 control participants were of similar demographics.

Dr. Gupta said more research is needed to understand the differences in pancreatic cancer risk between men and women and to understand why heavy alcohol use and binge drinking may increase the risk of pancreatic cancer in men.

Low Survival Rate Cancer

The next step, Dr. Gupta said, will be to see if other studies with detailed information on alcohol consumption and binge drinking have similar results.

Cancer of the pancreas, an organ important for digestion and production of hormones, has the lowest overall five-year survival rate of all specific cancers. Early signs of pancreatic cancer are difficult to diagnose, partly because the organ is located deep in the upper abdomen. Mortality rates have changed little in the past three decades, according to the National Cancer Institute.

Dr. Elizabeth Holly, who was the principal investigator, and Drs. Paige Bracci and Furong Wang also were involved in the UCSF study.

Posted by Webmaster at 09:43 AM


Alcohol Use Linked to Faster HIV Progression

HIV disease tends to progress at a faster rate in infected individuals who consume two or more alcoholic drinks a day, according to an important paper in AIDS Research and Human Retroviruses, a peer-reviewed journal published by Mary Ann Liebert, Inc.

The article, entitled "Alcohol Use Accelerates HIV Disease Progression," clearly demonstrates that frequent alcohol use, defined as two or more drinks daily, is associated with declining CD4+ cell counts (which indicate a weakened immune system) in individuals with HIV disease who either are or are not receiving antiretroviral therapy (ART). Based on the results of a 30-month prospective study, the authors, Marianna Baum, Carlin Rafie, Sabrina Sales, and Adriana Campa, from Florida International University (Miami), Shenghan Lai, from Johns Hopkins University, and John Bryan Page, from University of Miami, Florida, conclude that alcohol has a direct effect on CD4 cells and that the accelerated decline in CD4+ cell counts in frequent alcohol users is not simply due to poorer adherence to ART in this population.

Alcohol Consumption and HIV


Another article by Natascha Ching, Karin Nielsen-Saines, Jaime Deville, Lian Wei, Eileen Garratty, and Yvonne Bryson, from the David Geffen School of Medicine at UCLA, Los Angeles, CA, demonstrated that children who were infected with HIV while in utero via maternal-fetal transmission, were subsequently given antiretroviral therapy, and had no detectable HIV in their blood, still produced neutralizing antibodies against HIV, suggesting that low levels of viral replication might still be occurring despite drug therapy. In the article "Autologous Neutralizing Antibody to Human Immunodeficiency Virus-1 and Replication-Competent Virus Recovered from CD4+ T-Cell Reservoirs in Pediatric HIV-1—Infected Patients on HAART," the authors present data to support their conclusion that the children's CD4 T-cells may contain latent HIV reservoirs that formed early in life before antiretroviral therapy was initiated.

"It is important that HIV infected individuals make informed decisions relating to alcohol consumption. This article will help to achieve that goal," says Thomas Hope, PhD, Editor-in-Chief of AIDS Research and Human Retroviruses and Professor of Cell and Molecular Biology at the Feinberg School of Medicine, Northwestern University, Chicago, IL.

Posted by Webmaster at 09:39 AM


Delay in License Reinstatement Signals High Risk

Driver's license suspension has become the most widely used as well as effective method for incapacitating individuals who have been convicted of driving under the influence (DUI). A new study has found that encouraging license reinstatement with continued controls, such as interlocks as a condition of reinstatement, may be effective as long as they do not extend delays.

Results were published in Alcoholism: Clinical & Experimental Research.

Driver's License Suspension Reduces Recifivism


"Suspension of driving privileges is the major standard sanction for an impaired driving offense in the western world," explained Robert B. Voas, senior scientist and director of the Impaired Driving Center at the Pacific Institute for Research and Evaluation (PIRE). "Jail is used in most countries for multiple offenders and problem cases such as involvement in a crash causing injuries. But jail terms are generally too short to significantly reduce the risk the driver presents to the driving public. Research clearly shows that suspension reduces recidivism when compared to not suspending the offender, but it is far from a perfect system since studies show that up to 75 percent of offenders report illicit driving."

"The value of the sanction partly depends on drivers regarding a proper driving license as having great value," observed Paul R. Marques, senior research scientist with the Impaired Driving Center at PIRE. "Unfortunately it seems in recent years there are many more drivers who find the benefit of driving unlicensed to be an acceptable low-risk thing to do, probably because the perceived risk of consequences is small. This becomes a public danger for several reasons, not least of which is that an unlicensed driver is usually an uninsured driver. If we cannot adequately enforce license suspension, and if drivers do not feel threatened by loss of their licenses, then suspension cannot serve its intended purpose of restricting road use to those who abide by the laws."

50 Percent Delay Getting License Back

Researchers analyzed the driving records of 40 million drivers – three million of whom were convicted of DUI – from seven of the largest U.S. states during a seven-to14-year period of time.

"We found that 50 percent of second offenders delay reinstating for more than a year," said Voas. "Those that delay have higher recidivism rates after they are reinstated, suggesting – but not demonstrated in this study – that they will have higher crash rates. Additionally, one third of second offenders will never reinstate."

Alcohol-Involved Driving


"Maybe the single most interesting finding from this study is the relationship between risk indicators of impaired driving and the longer time delay in reinstatement after becoming eligible to reinstate," said Marques. "Drivers with more alcohol citations are less likely to reinstate promptly when eligible. What can we do to reduce the risk these drivers pose to the average road user? We need to either substantially increase monitoring and enforcement, and/or use other ways to control alcohol-involved driving."

Who are the DUI offenders who delay reinstatement after they become eligible? "It is probable that those who delay may do so because they have not satisfied other requirements such as attending and completing treatment, paying their fine, or meeting with their probation officer," said Voas. "Research suggests that failure to meet these responsibilities is an indication that they are more likely to resist conforming to rules and regulations generally, including traffic laws. They may also have more serious drinking problems which make it less likely that they can separate their drinking from their driving."

Repeat Offenders More Likely to Delay

"The delay in reinstatement is also correlated with having had more prior DUI convictions – multiple offenders are more likely to delay than first-time offenders – and those with more prior convictions generally have more future convictions," added Marques. "But also, there are usually more conditions placed on reinstatement for those perceived as having higher risk. There may be a break point where some offenders just do not want to bother with the burden of proper relicensing. We should not be making the relicensing process so onerous that we force people out of compliance with the laws."

Conversely, who are the DUI offenders who do reinstate? "Conforming to the requirements imposed by the courts and motor vehicle departments in a timely manner suggest that these individuals have taken advantage of treatment and other intervention programs provided by the state and have better control over their own behavior," said Voas. "The fact that first offenders, who have fewer drinking problems, are less likely than multiple offenders to delay suggests that the level of the offenders' drinking problem plays a role."

Driving While Suspended


People have different reasons to conform, observed Marques. "If you have a certain satisfaction with your life and want to retain privileges, conveniences, and fulfill responsibilities, then meeting the administrative and legal expectations around reinstatement is a no-brainer," he said. "Simply enough, those more invested in social norms are more apt to do things that are normative. For those who are more marginalized, whether through choice, income or opportunity, the risk-benefit ratio of either not relicensing, or choosing to drive while suspended, will be different."

"Our findings suggest that more attention should be given to DUI sanctions that maintain contact with the offender following reinstatement such as vehicle alcohol interlocks," said Voas. "The results also suggest that offenders who have delayed several months beyond their nominal reinstatement date might be reminded of the importance of reinstating, and of the sanctions for illicit driving."

"Our roadways are the national commons," added Marques. "It is silly to imagine that we can bring DUI behavior under control just by making laws that are more punitive or restrictive. The evidence developed by Voas and colleagues provides an estimate of problem magnitude and should ideally form the basis for policy innovations."

Posted by Webmaster at 09:34 AM


Teen Smokers Don't Recognize Signs of Dependence

Kids who have just started smoking, but not on a daily basis, don't seem to recognize the early symptoms of dependence, according to a study. Published in the journal Pediatrics by Chyke Doubeni, MD, MPH of the University of Massachusetts, the study found that among kids who have started smoking, "an urge to smoke or being irritable because they are not able to smoke is a sign of early dependence. But they don't seem to recognize that symptoms such as irritability are harbingers of addiction."

"Previous studies have already shown that there is a strong correlation between symptoms of nicotine dependence and nicotine addiction. This study shows that adolescents who start smoking, don't appear to recognize the early signs of dependence," Doubeni said. Other signs of early dependence that go unnoticed include experiencing a desire to smoke or craving for a cigarette.

Early Signs of Nicotine Dependence

The study concluded that nondaily use of tobacco can trigger any of these early signs of dependence. Early dependence promotes increased smoking. That in turn accelerates additional signs of dependence, which leads to even higher frequencies of smoking. Eventually, it leads to addiction.

The conclusions are based on a study that surveyed adolescent smokers every three to four months, over a four-year period from 2002-2006. The study found that over those four years, of the 370 subjects who had inhaled from a cigarette, 62% smoked at least once per month, 52% experienced dependence symptoms, and 40% went on to become daily smokers.

The study, "Early Course of Nicotine Dependence in Adolescent Smokers," provides additional evidence supporting the Food and Drug Administration's (FDA) recent rules placing restrictions on tobacco marketing to youth. Tobacco companies are challenging some of the FDA's rules in court.

Posted by Webmaster at 09:26 AM


Couples Therapy Best for Alcohol Dependent Women

Barbara McCrady and Elizabeth Epstein wanted to know whether cognitive behavior therapy worked better for alcohol-dependent women when delivered as couples therapy than when delivered as individual therapy. They reported recently that both treatment methods worked well, but women treated in couples therapy maintained their gains a bit better than those in individual therapy. Also, women suffering from depression in addition to alcohol-dependence did better in couples therapy. Their paper appeared in the Journal of Consulting and Clinical Psychology.

Epstein is an associate research professor at the Center of Alcohol Studies. McCrady, formerly a professor of psychology at Rutgers, now directs the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addictions.

Women Less Likely to Seek Treatment

Alcohol use disorders hit women particularly hard, physically and psychologically. Epstein and McCrady cite earlier studies’ findings that between 4 and 8 percent of women under age 44 are alcohol-dependent, that as many as 65 percent of alcohol-dependent women have some additional psychiatric disorder, and that women are less likely to seek treatment for alcoholism than men. Alcohol-dependent women have high rates of distressed marriages and not much support from members of their social networks when they try to break that dependence. Until recently, there has not been much research on unique treatments for alcohol use disorders in women.

McCrady and Epstein recruited 102 women with newspaper ads and referrals from other alcohol treatment programs. They were looking for women who were alcohol-dependent, married or in a committed relationship with a man for at least six months, and whose male partners were willing to participate in therapy.

Couples Therapy Helps

Both groups received 20 out-patient sessions of cognitive behavioral therapy over six months, for which the goal was abstinence from alcohol. Seven therapists, all trained both in individual and couples therapy, saw the clients. After the 20 sessions,, each participant received follow-up interviews on the phone and in person for another year. For each woman in each of the 18 months of the study, researchers calculated the percentage of days abstinent and the percentage of days of heavy (more than three drinks in a day) drinking.

Nearly half the women started abstaining before the first treatment session, the researchers wrote. For the first month of treatment, the abstinence rate for women still drinking in both groups rose sharply – more sharply for women in couples therapy, perhaps because they had a slightly lower rate of abstention to start with. During the year following treatment, the women in couples treatment reported fewer heavy drinking days than women in individual treatment.

Social Support Important

The researchers concluded that there is a widespread need for specific treatments for alcohol- dependent women, and that social support for change is important. However, not all women have spouses, and not all spouses are supportive. Epstein and McCrady are currently recruiting women for another study comparing individual and group therapy. Participants needn’t be married or in a committed relationship for this study. Interested participants can call 732 445- 0900 visit womenandalcohol.rutgers.edu. Learn more about other aspects of the research program and current opportunities for participating by clicking here.

These studies are funded by the National Institute of Alcohol Abuse and Alcoholism of the National Institutes of Health.

Posted by Webmaster at 09:20 AM


Watching R-Rated Movies Linked to Early Drinking

Middle-school children whose parents restrict access to R-rated movies are substantially less likely to start drinking than their peers who are allowed to see such films, a new study suggests. In a study of nearly 3,600 New England middle school students, researchers found that among kids who said their parents never allowed them to watch R movies, few took up drinking over the next couple years.

R-Rated Movies and Alcohol

Of that group, 3 percent said they had started drinking when questioned 13 to 26 months after the initial survey. That compared with 19 percent of their peers who'd said their parents "sometimes" let them see R-rated films, and one-quarter of students who'd said their parents allowed such movies "all the time."

The researchers say the findings, reported in the May issue of the Journal of Studies on Alcohol and Drugs, underscore the importance of parents paying close attention to their children's media exposure.

"We think this is a very important aspect of parenting, and one that is often overlooked," said Dr. James D. Sargent, a professor of pediatrics at Dartmouth Medical School in Hanover, New Hampshire.

Exposure to Adult Content

The current findings build on evidence linking children's exposure to R-rated movies and onscreen "adult" content in general not only to early drinking but also to early smoking and kids' likelihood of having sex or behaving violently.

"The research to date suggests that keeping kids from R-rated movies can help keep them from drinking, smoking and doing a lot of other things that parents don't want them to do," Sargent said.

He pointed out that it could be argued that parents who restrict access to R movies are simply more careful in general -- keeping tabs on their children's friends or making sure their kids have no access to alcohol at home, for instance. However, Sargent and his colleagues accounted for this in the current study by asking students questions that gauge "authoritative parenting" -- which gauges the adolescent's perception of parental responsiveness (ability to respond to the adolescent's point of view) and demandingness (ability to set and enforce limits).

The researchers found that, even with such factors considered, exposure to R-rated movies was still linked to the likelihood of early drinking.

Drinking in R-Rated Movies

Ninety percent of R-rated films have depictions of drinking, and that may be one reason that middle-schoolers who see the films are more vulnerable to early drinking. But Sargent said that the R-rated movie effect goes beyond that. Other research suggests that children who see R-rated movies become more prone to "sensation seeking" and risk taking. "We think seeing the adult content actually changes their personality," Sargent said.

The bottom line, according to the researcher, is that parents should restrict their kids from seeing R-rated films. But he also pointed out that PG-13 movies, as well as many TV shows, often portray drinking and other adult situations -- and that supports limiting children's media time in general.

The American Academy of Pediatrics currently recommends that children watch no more than one to two hours of "quality" media, including movies, TV and videos, each day.

Posted by Webmaster at 09:16 AM


Adolescent Drinking Adds to Breast Cancer Risk

Girls and young women who drink alcohol increase their risk of benign (noncancerous) breast disease, says a study by researchers at Washington University School of Medicine in St. Louis and Harvard University. Benign breast disease increases the risk for developing breast cancer.

"Our study clearly showed that the risk of benign breast disease increased with the amount of alcohol consumed in this age group," says Graham Colditz, MD, DrPH, associate director of prevention and control at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital. "The study is an indication that alcohol should be limited in adolescence and early adult years and further focuses our attention on these years as key to preventing breast cancer later in life."

Alcohol and Breast Cancer

The study was published in the journal Pediatrics.

About 80 percent of breast lumps are benign. But these benign breast lesions can be a step in a pathway leading from normal breast tissue to invasive breast cancer, so the condition is an important marker of breast cancer risk, Colditz indicates.

The researchers studied girls aged 9 to 15 years at the study's start and followed them using health surveys from 1996 to 2007. A total of 6,899 participants reported on their alcohol consumption and whether they had ever been diagnosed with benign breast disease. The participants were part of the Growing Up Today Study of more than 9,000 girls from all 50 states who are daughters of participants in the Nurses' Health Study II, one of the largest and longest-running investigations of factors that influence women's health.

The More Alcohol the Greater the Risk

The study showed that the more alcohol consumed, the more likely the participants were to have benign breast disease. Girls and young women who drank six or seven days a week were 5.5 times more likely to have benign breast disease than those who didn't drink or who had less than one drink per week. Participants who reported drinking three to five days per week had three times the risk.

The participants who were diagnosed with benign breast disease on average drank more often, drank more on each occasion and had an average daily consumption that was two times that of those who did not have benign breast disease. They also had more episodes of binge drinking.

Drinking Increases Breast Cancer Risks

The study is unique because it asked about alcohol intake while participants were adolescents instead of asking them to recall many years later how often they drank.

"We know from many other studies of adult women that alcohol intake later in life increases breast cancer risk," Colditz says. "But many women begin drinking alcohol as adolescents right at the time in which breast tissue is going through stages of rapid proliferation. So we wanted to see if the effect of alcohol on breast cancer risk was operative in this younger group."

The results of this study provide more evidence that steps can be taken to prevent breast cancer.

"There's growing evidence that physical activity can lower breast cancer risk," Colditz says. "We also know that diet and weight are important factors. Now it is clear that drinking habits throughout life affect breast cancer risk, as well."

Posted by Webmaster at 09:09 AM


Test Could Identify Smokers at Risk of Emphysema

Using CT scans to measure blood flow in the lungs of people who smoke may offer a way to identify which smokers are most at risk of emphysema before the disease damages and eventually destroys areas of the lungs, according to a University of Iowa study.

The study found that smokers who have very subtle signs of emphysema, but still have normal lung function, have very different blood flow patterns in their lungs compared to non-smokers and smokers without signs of emphysema.

Smokers and Emphysema

This difference could be used to identify smokers at increased risk of emphysema and allow for early intervention. The findings appear this week in the Early Edition of the Proceedings of the National Academy of Sciences.

"We have developed a new tool to detect early emphysema-related changes that occur in smokers who are susceptible to the disease," said lead study author Eric Hoffman, Ph.D., UI professor of radiology, internal medicine and biomedical engineering. "Our discovery may also help researchers understand the underlying causes of this disease and help distinguish this type of emphysema from other forms of chronic obstructive pulmonary disease. This type of CT scan could even be a tool to test the effectiveness of new therapies by looking at the changes in lung blood flow."

Targeting COPD

As many as 24 million Americans have chronic obstructive pulmonary disease (COPD) -- a group of serious lung diseases that includes emphysema -- and COPD is the fourth leading cause of death nationwide. Because COPD is a group of different diseases, identifying more effective treatments may hinge on distinguishing between these diseases and targeting them separately.

The team used multi-detector row CT imaging to measure blood flow patterns in the lungs of 41 study participants -- 17 non-smokers and 24 smokers. All the participants had normal lung function, but 12 of the smokers had very subtle signs of emphysema. The CT scans showed that these 12 individuals had the most disrupted patterns of blood flow compared to the other participants.

The findings also support the idea that abnormal blood flow occurs before emphysema develops.

"Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease," Hoffman said. "Our study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate."

Repairing the Damage

The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung "optimizes gas exchange" and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.

This study suggests that the ability to distinguish when to turn off or when to ramp up blood flow is defective in some people -- probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.

Posted by Webmaster at 09:05 AM


Cocaine Use a Significant Teen HIV Risk Factor

Teens with a history of crack or cocaine use are significantly more likely to engage in unprotected sex than youth who have never used these drugs, putting themselves at increased risk for HIV, according to a study in the Journal of Child and Adolescent Substance Abuse.

Researchers from the Bradley Hasbro Children's Research Center report that teens in psychiatric care who used crack and/or cocaine at least once were six times more likely to use condoms inconsistently, which was defined as "sometimes," "never" or "rarely." The findings suggest that crack cocaine appears to have more of an influence on risky teen behaviors than other factors, like alcohol and marijuana use, which are more routinely incorporated into adolescent HIV prevention interventions.

Cocaine and Unprotected Sex


The study is one of the first to look at the link between crack and cocaine use and HIV risk behaviors in adolescents. Previous research has demonstrated this association in adults.

"Unprotected sex is the most common way that HIV is transmitted among teens, so if we can develop a clearer picture of why some kids engage in high-risk sexual behaviors, we will be better prepared to educate them about safe sex," says lead author Marina Tolou-Shams, PhD, of the Bradley Hasbro Children's Research Center. "Our findings suggest that future HIV prevention interventions should include content specific to crack and cocaine use, just as they do with drugs that are more commonly used by teens, like alcohol and marijuana."

Overall, nearly 280 teens between the ages of 13 and 18 from therapeutic psychiatric day programs took part in the study. Participants exhibited a range of psychiatric diagnoses, including mood disorders, post-traumatic stress disorder and disruptive behavior disorders. More than half of all adolescents were male, and more than three-quarters were Caucasian. Approximately 13 percent of teens in the study reported trying crack or cocaine at least once.

Not Using Condoms


After controlling for known adolescent HIV risk factors, such as gender, race, age and psychiatric status, researchers found that only 47 percent of teens with a history of crack and/or cocaine use said they used condoms "always or almost always." In addition, 15 percent of these adolescents have a history of sexually transmitted diseases (STD), nearly three-quarters reported using alcohol at least once and more than half indicated prior marijuana use.

In comparison, 71 percent of teens who never used crack or cocaine reported using condoms consistently.

Tolou-Shams says it was important to look at the association between crack and cocaine use and HIV risk behavior in adolescents with psychiatric disorders, since previous research has shown that teens in mental health treatment have high rates of risky sexual behavior and are more likely to engage in substance use.

"Our study clearly shows that youth in psychiatric treatment are using other drugs – and not just alcohol or marijuana – at high rates and that a history of drug use should alert clinicians to a wide variety of possible behavioral risks in their young patients," she adds.

Provide Interventions


The authors recommend that all clinicians who treat adolescents – including pediatricians, social workers and psychologists – routinely discuss their patients' mental health history, lifetime use of all substances and sexual activity, as well as provide appropriate interventions when necessary in order to reduce their HIV risk.

The research is supported by grants from the National Institute of Mental Health and the Lifespan/Tufts/Brown Center for AIDS Research (CFAR).

Tolou-Shams is also an assistant professor of psychiatry at The Warren Alpert Medical School of Brown University. Study co-authors include Larry K. Brown, MD, and Nicholas Tarantino, BS, both from the Bradley Hasbro Children's Research Center and Alpert Medical School, and Sarah W. Feldstein Ewing, PhD, at the University of New Mexico.

Posted by Webmaster at 09:01 AM


Risky Drinkers Less Likely to Seek Medical Care

Women and men who engage in frequent heavy drinking report significantly worse health-related practices, according to a Kaiser Permanente Center for Health Research study in the journal Addiction Research & Theory. For the study, researchers surveyed 7,884 members of the Kaiser Permanente Northwest integrated health plan in Oregon and Washington.

They found that risky drinkers have attitudes and practices that may adversely affect their long-term health and that people who drink at hazardous levels were less likely than other categories of drinkers to seek routine medical care.

At-Risk Drinkers

Risky drinking was defined in three different ways to account for both short and long-term alcohol-related risks: 1) those who, on average, drank three or more drinks per day, 2) women who consumed four or more drinks during one sitting, or men who drank five or more drinks during one sitting, or 3) people identified as at-risk drinkers using a commonly used screening tool.

"The main finding here is that risky drinkers also engage in other behaviors--such as relieving stress with alcohol and cigarettes, not wearing seatbelts, unhealthy eating and not regularly seeing their doctors--that put their health at risk," said study lead author Carla Green, a senior investigator at the Kaiser Permanente Center for Health Research. "Physicians should not only be concerned about patients' heavy drinking, but also these other health-related practices."

The study, funded by the National Institute on Alcohol Abuse and Alcoholism, is the first to examine the relationship between drinking patterns and health while taking into account a wide-range of other factors that might influence that relationship.

Drinking Patterns and Health

Those factors include diet, exercise, stress management, sleep practices, seat belt use, income, education, obesity, as well as feelings about seeing the doctor, skepticism toward medical care, and attitudes about personal ability to influence health.

"Our study found that men and women who drank the most had less collaborative relationships with their doctors and were more likely to dislike going to the doctor. They were also less confident they could change their own health-related practices and more likely to think health is a matter of good fortune," Green said.

While the study clearly showed a negative relationship between health and daily, heavy drinking, it also found that moderate drinking was associated with better health. In fact, on a standard health status survey, people who drank one-to-three drinks daily reported slightly better health than all other categories of drinkers, including life-long abstainers, former drinkers, light drinkers (less than one drink a day) and heavier drinkers (three or more drinks per day). People who drank moderately were also more likely to have better health-related attitudes and practices, and more likely to seek routine medical care.

Moderate Drinkers Healthier

"Even after taking these other health-related attitudes and practices into account, there was still a small but independent relationship between moderate drinking and better self-assessed health," said Michael Polen, study co-investigator at the Kaiser Permanente Center for Health Research. "Previous research has linked moderate alcohol drinking with cardiovascular benefits, so that might be the underlying reason moderate drinkers report better health. It's also possible that there are additional factors we didn't measure that account for this positive relationship."

The study was conducted by reviewing mail-survey responses of 7,884 Kaiser Permanente members from 2002 and 2003. The survey was linked to two years of electronic health records and service use data to study how drinking patterns affect willingness to seek health care. Each of the members, aged 18 to 64, responded to a survey that measured physical and mental health as well as health-related attitudes and practices.

Posted by Webmaster at 08:52 AM


Proteins May Provide New Alcohol Use Test

Measuring a set of protein changes in the blood linked to alcohol use may potentially lead to a more accurate diagnostic test than those previously available, according to Penn State College of Medicine researchers.

"The challenge in alcohol abuse as opposed to substance abuse -- things like cocaine or heroin or PCP -- is that alcohol is a perfectly legal substance for those over 21," said Willard M. Freeman, Ph.D., department of pharmacology and lead investigator. "Unlike routine testing for illicit drugs, you can't just look for a trace of alcohol because many people enjoy a drink in a responsible manner and alcohol is very quickly metabolized. Discriminating between excessive and responsible levels of drinking makes this a greater challenge."

Proteins Predict Alcohol Use

Penn State Hershey researchers, working for two-and-a-half years in cooperation with Kathleen A. Grant, Ph.D., at the Oregon National Primate Research Center, identified a set of 17 proteins in the blood that accurately predicted alcohol usage 90 percent of the time in non-human primates. Researchers were able to separate usage into three categories -- no alcohol use, drinking up to two drinks per day and drinking at least six drinks per day.

Protein levels rose and declined depending on alcohol consumption.

"We observed that the levels of some proteins increased or decreased with as little as one or two drinks a day," Freeman said. "These same changes occurred with heavier levels of drinking. We also found other proteins that responded only to heavy levels of drinking. Combined, these proteins allow us to classify subjects into non-drinking, alcohol-using, and alcohol-abusing groups."

The researchers are continuing their work, first by determining whether the changes measured return to normal levels with cessation of drinking. Second, they are looking for additional proteins to both increase accuracy and provide alternates if some of the initial 17 do not work in humans.

Working with groups around the world, Penn State Hershey researchers -- led by Freeman and Kent Vrana, chair, department of pharmacology -- plan to collect blood from people undergoing inpatient treatment for alcohol abuse.

Testing for Abstinence


"We'll collect blood throughout their stay to see if the patients' protein pattern reverts from an excessive drinking pattern to a pattern that's indicative of alcohol abstinence," Freeman said.

The goal is to create a diagnostic test for alcohol consumption that may be used in areas of public safety like aviation or national security, for parole conditions and for helping physicians determine if a patient may have an alcohol abuse problem. Currently there are tests that try to address this issue, but Freeman said these tests are not sensitive and specific enough to serve as diagnostics.

"Many of these tests rely on just one protein," he said. "The limitation to this approach is that these tests often look at proteins produced by the liver. While these proteins increase with excessive alcohol intake, they also increase with any type of injury to the liver. For example, a lot of prescription drugs are hard on the liver. These tests let us know that the liver is being stressed but can't discriminate between excessive drinking and other conditions, which therefore reduces the utility of these tests.

"That's where we see the promise in this panel of proteins. The proteins are produced by a number of organs including the liver, the muscle, and the brain. This unique fingerprint that is indicative of alcohol abuse is less likely to be produced by unrelated conditions."

Freeman stresses, a diagnostic test would not be testing for alcoholism, but rather, alcohol intake.

Amount of Drinking Test


"In a strictest use of the words, alcoholism is a psychological diagnosis as opposed to a level of drinking," he said. "The Diagnostic and Statistical Manual really classifies alcohol abuse and alcoholism based on how alcohol is interfering with your life. Obviously we can't use a blood test to say yes, your drinking is interfering with your home life. But the amount of drinking and the amount of problems it causes in your life are tightly correlated.

"We envision, a number of years down the line if this becomes a diagnostic test, that if the test indicates that you're drinking a lot, it would prompt a referral to a specialist in alcohol abuse and alcoholism. This test could provide an objective indicator to help people begin addressing what may really be a problem in their lives."

Posted by Webmaster at 08:49 AM


How Fast Does Nicotine Peak in the Brain?

Nicotine takes much longer than previously thought to reach peak levels in the brains of cigarette smokers, according to new research conducted at Duke University Medical Center.

Traditionally, scientists thought nicotine inhaled in a puff of cigarette smoke took a mere seven seconds to be taken up by the brain, and that each puff produced a spike of nicotine. Using PET imaging, Duke investigators illustrate, for the first time, that cigarette smokers actually experience a steady rise of brain nicotine levels during the course of smoking a whole cigarette.

The findings, scheduled to appear online in the Early Edition of Proceedings of the National Academy of Sciences (PNAS), could lead to more effective treatments for smoking addiction.

Nicotine Accumulates in the Brain

"Previously it was thought that the puff-by-puff spikes of nicotine reaching the brain explained why cigarettes are so much more addictive than other forms of nicotine delivery, like the patch or gum," says Jed Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research. "Our work now calls into question whether addiction has to do with the puff-by-puff delivery of nicotine. It may actually depend in part on the overall rate at which nicotine reaches and accumulates in the brain, as well as the unique habit and sensory cues associated with smoking."

Yet, when the researchers compared 13 dependent smokers to 10 non-dependent smokers, they were surprised to find the dependent smokers had a slower rate of nicotine accumulation in the brain. "This slower rate resulted from nicotine staying longer in the lungs of dependent smokers, which may be a result of the chronic effects of smoke on the lungs," surmises Rose.

The difference in rate of nicotine accumulation in the brain doesn't explain why some people become addicted to cigarettes and others don't. "Even if you correct for the speed of delivery, our study showed the non-dependent smokers eventually experienced the same high levels of nicotine in their brain as dependent smokers, yet they did so without becoming dependent. The real mystery is why."

Sensitivity to Nicotine

Rose says the absence of addiction in these smokers could be due to genetic differences, differences in the way they smoke, or differences in the psychological effects they derive. "We're still not able to fully explain why these people are able to smoke without becoming addicted."

Despite the questions raised, the study provides important insights into the role of the speed and level of brain nicotine levels, and which receptors in the brain are at work. "Different receptors respond to nicotine at different levels of sensitivity," says Rose. "Knowing the levels of nicotine that are really getting to the brain gives us clues as to which receptors are more likely to be important for the dependence-producing effects of cigarette smoking."

Posted by Webmaster at 03:22 AM


Long-Time Cannabis Use Linked to Psychosis

Young adults who have used cannabis or marijuana for a longer period of time appear more likely to have hallucinations or delusions or to meet criteria for psychosis, according to a report in the Archives of General Psychiatry, one of the JAMA/Archives journals.

Previous studies have identified an association between cannabis use and psychosis, according to background information in the article. However, concerns remain that this research has not adequately accounted for confounding variables.

Cannabis Use and Psychotic Outcomes

John McGrath, M.D., Ph.D., F.R.A.N.Z.C.P., of the Queensland Brain Institute, University of Queensland, Australia, and colleagues studied 3,801 young adults born between 1981 and 1984. At a 21-year follow-up, when participants were an average age of 20.1, they were asked about cannabis use in recent years and assessed using several measures of psychotic outcomes (including a diagnostic interview, an inventory of delusions and items identifying the presence of hallucinations).

At the 21-year follow-up, 17.7 percent reported using cannabis for three or fewer years, 16.2 percent for four to five years and 14.3 percent for six or more years. Overall, 65 study participants received a diagnosis of "non-affective psychosis," such as schizophrenia, and 233 had at least one positive item for hallucination on the diagnostic interview.

Among all the participants, a longer duration since the first time they used cannabis was associated with multiple psychosis-related outcomes. "Compared with those who had never used cannabis, young adults who had six or more years since first use of cannabis (i.e., who commenced use when around 15 years or younger) were twice as likely to develop a non-affective psychosis and were four times as likely to have high scores on the Peters et al Delusions Inventory [a measure of delusion]," the authors write. "There was a 'dose-response' relationship between the variables of interest: the longer the duration since first cannabis use, the higher the risk of psychosis-related outcomes."

Not a Simple Connection

In addition, the researchers assessed the association between cannabis use and psychotic symptoms among a subgroup of 228 sibling pairs. The association persisted in this subgroup, "thus reducing the likelihood that the association was due to unmeasured shared genetic and/or environmental influences," the authors continue.

"The nature of the relationship between psychosis and cannabis use is by no means simple," they write. Individuals who had experienced hallucinations early in life were more likely to have used cannabis longer and to use it more frequently. "This demonstrates the complexity of the relationship: those individuals who were vulnerable to psychosis (i.e., those who had isolated psychotic symptoms) were more likely to commence cannabis use, which could then subsequently contribute to an increased risk of conversion to a non-affective psychotic disorder."

The findings should encourage further research to elucidate the mechanisms underlying the relationship between psychosis and cannabis use, the authors conclude.

Posted by Webmaster at 03:17 AM


Smoking Cessation Therapy Proves Promising

A novel technology for delivering nicotine to the lungs may soon give smokers a new way to kick the habit. When compared to the nicotine vapor delivery system used in the Nicotrol/Nicorette inhaler, the new technology proved more effective at delivering nicotine to the blood stream.

As a result, it provides immediate relief of withdrawal symptoms, according to Duke University Medical Center researchers. Users also reported the new nicotine delivery method was more tolerable than the current inhaler because it caused less throat irritation.

Smoking Without Danger?

"We wanted to replicate the experience of smoking without incurring the dangers associated with cigarettes, and we wanted to do so more effectively than the nicotine replacement therapies currently on the market," said Jed Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research where the technology is being developed. He presented the data at the Society for Nicotine and Tobacco Research (SRNT) in Baltimore, MD.

The Nicotrol inhaler is a smoking cessation therapy that delivers nicotine vapor to the mouth and upper airways, but little of it reaches the lungs.

Duke's new technology employs a unique method to deliver nicotine to the lungs. In today's presentation, the researchers show the new lung delivery technology results in rapid absorption of nicotine that provides immediate relief of withdrawal symptoms and also re-creates some of the familiar sensations that are pleasurable to smokers.

Current methods that deliver medicine to the lungs -- metered dose sprays, dry powder inhalers or nebulizers that create a fine mist – do not replicate the natural inhalation used by smokers when drawing on a cigarette. And, because medication residue often deposits in the mouth and throat, doses aren't always high enough to ensure the appropriate amount reaches the lungs.

Combining Two Vapors


Duke's new technology combines the vapor phase of pyruvic acid, which occurs naturally in the body, and nicotine. "When the two vapors combine, they form a salt called nicotine pyruvate," explains Rose. "This reaction transforms invisible gas vapors into a cloud of microscopic particles which is inhaled, just like a smoker inhales from a cigarette."

In a study of the new Duke technology, nine healthy smokers inhaled 10 puffs of nicotine pyruvate in increasing doses, 10 puffs from a Nicotrol/Nicorette inhaler cartridge, and 10 puffs of room air (placebo). Blood was drawn before and after each set of inhalations. When the results were analyzed, the Duke researchers noted rapid increases in plasma nicotine concentrations following the nicotine pyruvate inhalations and less complaints of harshness/irritation when compared to the Nicotrol/Nicorette control cartridge. The smokers also said their cravings for cigarettes were substantially alleviated following the nicotine pyruvate inhalations.

"Compared to the current nicotine vapor inhaler, we are able to give smokers more nicotine, although still less than a cigarette, with less irritation, resulting in reduced cravings," said Rose. "Thus we are able to achieve a therapeutic effect with greater tolerability."

More research is needed to examine the safety and effectiveness of prolonged use of the inhalation system, and to assess its role in helping people quit smoking. But, Rose says if all goes well, he anticipates the product could become commercially available within three to five years.

He also says the novel inhalation system may one day prove useful for delivery of other medications. Duke has filed patent applications on the new technology, which was invented by Rose and his colleagues, including his brother, Seth D. Rose, Ph.D., Duke colleague, Thangaraju Murugesan, Ph.D., and James E. Turner, an inventor of the Nicotrol/Nicorette inhaler.

Posted by Webmaster at 03:14 AM


Alcohol, Energy Drinks A Dangerous Mix

Energy drinks, favored among young people for the beverages' caffeine jolt, also play a lead role in several popular alcoholic drinks, such as Red Bull and vodka. But combining alcohol and energy drinks may create a dangerous mix, according to University of Florida research.

In a study of college-aged adults exiting bars, patrons who consumed energy drinks mixed with alcohol had a threefold increased risk of leaving a bar highly intoxicated and were four times more likely to intend to drive after drinking than bar patrons who drank alcohol only.

Eliminates Sedating Effects of Alcohol


The study appears in the journal Addictive Behaviors.

"Previous laboratory research suggests that when caffeine is mixed with alcohol it overcomes the sedating effects of alcohol and people may perceive that they are less intoxicated than they really are," said the study's lead researcher Dennis Thombs, an associate professor in the UF College of Public Health and Health Professions' department of behavioral science and community health. "This may lead people to drink more or make uninformed judgments about whether they are safe to drive."

Experts believe that among college drinkers, as many as 28 percent consume alcohol mixed with energy drinks in a typical month.

The UF study is the first of its kind to evaluate the effects of alcohol mixed with energy drinks in an actual drinking environment, that is, at night outside bars. Research on college student alcohol use in campus communities has traditionally relied on self-report questionnaires administered to sober students in daytime settings, Thombs said.

Data for the UF study were collected in 2008 from more than 800 randomly selected patrons exiting establishments in a college bar district between the hours of 10 p.m. and 3 a.m. Researchers conducted face-to-face interviews with participants to gather demographic information and details on participants' energy drink consumption and drinking behavior. Participants also completed self-administered questionnaires that asked
about their drinking history and intention to drive that night. Next, researchers tested participants' breath alcohol concentration levels. Participants received feedback on their intoxication levels and advice about driving risk.

Wide Awake Drunks


Bar patrons who reported drinking alcohol mixed with energy drinks -- 6.5 percent of study participants -- were three times more likely to be intoxicated than drinkers who consumed alcohol only. The average breath-alcohol concentration reading for those who mixed alcohol and energy drinks was 0.109, well above the legal driving limit of 0.08. Consumers of energy drink cocktails also left bars later at night, drank for longer periods of time, ingested more grams of ethanol and were four times more likely to express an intention to drive within the hour than patrons who drank alcohol only.

Consumers of alcohol mixed with energy drinks may drink more and misjudge their capabilities because caffeine diminishes the sleepy feeling most people experience as they become intoxicated. It's a condition commonly described as "wide awake and drunk," said study co-author Bruce Goldberger, a professor and director of toxicology in the UF College of Medicine.

"There's a very common misconception that if you drink caffeine with an alcoholic beverage the stimulant effect of the caffeine counteracts the depressant effect of the alcohol and that is not true," Goldberger said. "We know that caffeine aggravates the degree of intoxication, which can lead to risky behaviors."

The study, funded by the University of Florida Office of the President, raises a lot of questions and suggests topics for future research, Thombs said.

Unsafe Levels of Caffeine?


"This study demonstrates that there definitely is reason for concern and more research is needed," he said. "We don't know what self-administered caffeine levels bar patrons are reaching, what are safe and unsafe levels of caffeine and what regulations or policies should be implemented to better protect bar patrons or consumers in general."

Thombs' study is a very valuable addition to the existing body of research on the association of energy drink consumption and alcohol-related consequences, said Dr. Mary Claire O'Brien, an associate professor of emergency medicine and public health sciences at Wake Forest University who has studied the relationship between energy drink cocktails and high-risk behavior.

"His approach is unique because it was conducted in a natural drinking environment — college bars," O'Brien said. "His results clearly support the serious concern raised by previous research, that subjective drunkenness may be reduced by the concurrent ingestion of caffeinated energy drinks, increasing both the likelihood of further alcohol consumption, and of driving when intoxicated."

Posted by Webmaster at 03:09 AM


More Alcohol Outlets Mean More Violence

More alcohol sales sites in a neighborhood equates to more violence, and the highest assault rates are associated with carry-out sites selling alcohol for off-premise consumption, according to new research released by two Indiana University professors.

Using crime statistics and alcohol outlet licensing data from Cincinnati, Ohio, to examine the spatial relationship between alcohol outlet density and assault density, Department of Criminal Justice professor William Alex Pridemore and Department of Geography professor Tony Grubesic found that off-premise outlets appeared to be responsible for about one in four simple assaults and one in three aggravated assaults.

Easier Alcohol Availability

The findings were released at the annual meeting of the American Association for the Advancement of Science in San Diego, Calif.

"A higher density of alcohol sales outlets in an area means closer proximity and easier availability to an intoxicating substance for residents," Pridemore said. "Perhaps just as importantly, alcohol outlets provide a greater number of potentially deviant places. Convenience stores licensed to sell alcohol may be especially troublesome in this regard, as they often serve not only as sources of alcohol but also as local gathering places with little formal social control."

Using different suites of spatial regression models, the researchers found that adding one off-premise alcohol sales site per square mile would create 2.3 more simple assaults and 0.6 more aggravated assaults per square mile. Increases in violence associated with restaurants and bars were smaller but still statistically significant, with 1.15 more simple assaults created when adding one restaurant per square mile, and 1.35 more simple assaults per square mile by adding one bar.

"We could expect a reduction of about one-quarter in simple assaults and nearly one-third in aggravated assaults in our sample of Cincinnati block groups were alcohol outlets removed entirely," Grubesic noted. "These represent substantial reductions and clearly reveal the impact of alcohol outlet density on assault density in our sample."

Alcohol Sales and Crime

The study examined 302 geographic block groups that encompassed all of Cincinnati, with each block group containing about 1,000 residents. Block groups are subdivisions of census tracks and represent the smallest unit available for socioeconomic analysis using data from the Census Bureau.

Crime statistics from January through June 2008 provided by the Cincinnati Police Department found 2,298 simple assaults and another 479 serious assaults had occurred in the study area during that time. The location of each of these criminal events was geocoded to show the precise location where they occurred. The researchers, using data from the Ohio Division of Liquor Control for Hamilton County, Ohio, then used the same geocoding techniques to spatially aggregate the city's 683 unique alcohol sales outlets into those block groups. The arithmetic mean, or average, density of assaults was 69 per square mile, while the average density of alcohol outlets per square mile was 20.

The researchers pointed to possible implications from the research on both public policy and on future research within the field of criminology. Pridemore said ecological studies of alcohol and violence similar to this one, while appearing more and more over the past 20 years in journals of disciplines like public health, geography and epidemiology, have been rare in criminology journals.

Alcohol and Violence

"We believe that alcohol outlets, as a source of community-level variation in levels of interpersonal violence, deserve greater attention in the criminological literature," he said. "The nature of our findings should encourage further investigation of the nature of the ecological association between alcohol, violence and other negative outcomes within communities."

Grubesic said explanations for crime ecological theories like collective efficacy, social disorganization and social cohesion rely on elements like poverty, ethnic heterogeneity, residential mobility, anonymity of community members and willingness to intervene on another's behalf, are difficult to remedy through public policy. That is not the case with alcohol outlet density, he said.

"Alcohol outlet density, on the other hand, is much more amenable to policy changes," Grubesic pointed out. "Unlike other negative neighborhood characteristics that often seem intractable, regulating the density of outlets, and to some extent their management, can be readily addressed with a mixture of policies by liquor licensing boards, the police and government agencies that regulate land use."

Posted by Webmaster at 03:03 AM


August 12, 2017

Social Factors Affect Alcohol Misuse Among Seniors

Social factors have consistently been implicated as a cause of vulnerability to alcohol use and abuse. The reverse is also true, in that individuals who engage in excessive drinking may alter their social context. New research on drinking among older adults has found that older adults who have more money, engage in more social activities, and whose friends approve more of drinking are more likely to engage in excessive or high-risk drinking.

"Ours is one of the first studies to focus longitudinally on high-risk drinking among older adults," said Rudolf H. Moos, senior research career scientist for the Department of Veterans Affairs Health Care System in Palo Alto, California, as well as corresponding author for the study, "and the first to have 10-year and 20-year follow-ups addressing this issue."

Social and Financial Influences


Moos and his colleagues examined 719 (399 men, 320 women) 55 to 65-year-old adults at baseline (between 1986-1988), and then again 10 and 20 years later. At each contact point, participants provided information regarding their drinking, as well as their social and financial resources.

"Our findings show that, one, certain social factors may enhance the chances of an individual engaging in high-risk drinking and, two, once high-risk drinking has developed, social choices may be made to facilitate continuing this behavior," said Moos.

More specifically, results showed that older adults who have more money, who engage in more social activities, and whose friends approve more of drinking are more likely to engage in what is considered high-risk drinking: more than three drinks per day or more than 14 drinks per week.

"These findings show that social contextual models of alcohol use apply to older drinkers," observed Charles J. Holahan, a professor in the department of psychology at The University of Texas at Austin. "The findings undercut the assumption of a solely dispositional view of drinking among older adults, whose alcohol use might easily be assumed to be outside the sway of social influences after a lifetime of drinking. They also provide a textured picture of two processes that link social context and alcohol misuse in a reciprocal way—social causation, whereby social context shapes alcohol use, and social selection, whereby alcohol use in turn shapes social context."

"Older adults who engage in high-risk alcohol consumption tend to select friends who are more likely to drink and to approve of drinking," said Moos. "They may also experience a decline in the quality of relationships with extended family members, that is, high-risk drinking may impair some family relationships. Compared to older women, older men may be more vulnerable or susceptible to some social influences on drinking. Specifically, having more money, and friends who approve more of drinking, seem to be more closely related to high-risk drinking among older men than among older women."

Alcohol Problems Don't Go Away


"The findings serve to undercut a solely person-blame approach to later life drinking," said Holahan. "They demonstrate that a spouse and friends can make a constructive difference in later life drinking. However, a spouse and friends can also unwittingly become caught up as facilitators in the process of later life drinking. The findings also encourage awareness that alcohol misuse does not go away with aging. Although alcohol consumption declined with aging, at the 20-year follow-up more than 20 percent of adults aged 75 to 85 still engaged in high-risk alcohol consumption."

"This information can be used to teach older adults, and family members and friends who care about and have some responsibility for them, about how to avoid or minimize 'triggers,' such as specific social activities or interactions with friends associated with heavy drinking," said Moos. "While this type of information might be useful for brief interventions for older adults in primary care or community settings, there is no inherent reason why family members and friends of older adults who engage in excessive drinking could not use it."

Posted by Webmaster at 10:48 PM