August 27, 2018

Study: No Safe Level of Alcohol Consumption

Alcohol is a leading risk factor for death and disease worldwide, and is associated with nearly one in 10 deaths in people aged 15-49 years old, according to a Global Burden of Disease study published in The Lancet that estimates levels of alcohol use and health effects in 195 countries between 1990 to 2016.


"The health risks associated with alcohol are massive," said Dr. Emmanuela Gakidou of the Institute for Health Metrics and Evaluation at the University of Washington and the senior author of the study. "Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss."

2 Billion Current Drinkers

The study does not distinguish between beer, wine, and liquor due to a lack of evidence when estimating the disease burden, Gakidou said.

However, researchers used data on all alcohol-related deaths generally and related health outcomes to determine their conclusions.

Alcohol use patterns vary widely by country and by sex, the average consumption per drinker, and the attributable disease burden. Globally, more than 2 billion people were current drinkers in 2016; 63% were male.

Standard Drink: 10 grams

"Average consumption" refers to a standard drink, defined in the study as 10 grams of pure alcohol, consumed by a person daily, about the equivalent of:

  • A small glass of red wine (100 ml or 3.4 fluid ounces) at 13% alcohol by volume;
  • A can or bottle of beer (375 ml or 12 fluid ounces) at 3.5% alcohol by volume; or
  • A shot of whiskey or other spirits (30 ml or 1.0 fluid ounces) at 40% alcohol by volume.

"Standard drinks" are different by country. For example, in the UK a standard drink is 8 grams of alcohol, whereas in Australia, the US, and Japan, it is 10 grams, 14 grams, and 20 grams, respectively.

Deaths, Diseases and Injuries

The study, part of the annual Global Burden of Disease (GBD), assesses alcohol-related health outcomes and patterns between 1990 and 2016 for 195 countries and territories and by age and sex.

It provides findings on prevalence of current drinking, prevalence of abstention, alcohol consumption among current drinkers, and deaths and overall poor health attributable to alcohol for 23 health outcomes, such as communicable and non-communicable diseases and injuries, including:

  • Cardiovascular diseases: atrial fibrillation and flutter, hemorrhagic stroke, ischemic stroke, hypertensive heart disease, ischemic heart disease, and alcoholic cardiomyopathy;
  • Cancers: breast, colorectal, liver, esophageal, larynx, lip and oral cavity, and nasal;
  • Other non-communicable diseases: cirrhosis of the liver due to alcohol use, diabetes, epilepsy, pancreatitis, and alcohol use disorders;
  • Communicable diseases: lower respiratory infections and tuberculosis;
  • Intentional injuries: interpersonal violence and self-harm;
  • Unintentional injuries: exposure to mechanical forces; poisonings; fire, heat, and hot substances; drowning; and other unintentional injuries; and
  • Transportation-related injuries.

Major Cause of Death

"We now understand that alcohol is one of the major causes of death in the world today," said Lancet Editor Richard Horton. "We need to act now. We need to act urgently to prevent these millions of deaths. And we can."

This study used 694 data sources on individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use. More than 500 GBD collaborators, such as researchers, academics, and others from more than 40 nations contributed to the study, according to Max Griswold, senior researcher and lead author.

"With the largest collected evidence base to date, our study makes the relationship between health and alcohol clear - drinking causes substantial health loss, in myriad ways, all over the world," Griswold said.

Drinking Rates by Nation

In 2016, eight of the leading 10 countries with lowest death rates attributable to alcohol use among 15- to 49-year-olds were in the Middle East: Kuwait, Iran, Palestine, Libya, Saudi Arabia, Yemen, Jordan, and Syria. The other two were Maldives and Singapore.

Conversely, seven of the leading 10 countries with highest death rates were in the Baltic, Eastern European, or Central Asian regions, specifically Russia, Ukraine, Lithuania, Belarus, Mongolia, Latvia, and Kazakhstan. The other three were Lesotho, Burundi, and Central African Republic.

Health officials in those nations, Gakidou said, would be well served by examining the study's findings to inform their policies and programs to improve the health and well-being of their constituents.

"There is a compelling and urgent need to overhaul policies to encourage either lowering people's levels of alcohol consumption or abstaining entirely," she said. "The myth that one or two drinks a day are good for you is just that - a myth. This study shatters that myth."

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August 23, 2018

Teen Drinking Linked to Increased Prostate Cancer Risk

Compared with non-drinkers, men who consumed at least seven drinks per week during adolescence (ages 15-19) had three times the odds of being diagnosed with clinically significant prostate cancer.

"The prostate is an organ that grows rapidly during puberty, so it's potentially more susceptible to carcinogenic exposure during the adolescent years," said author Emma Allott. "For this reason, we wanted to investigate if heavy alcohol consumption in early life was associated with the aggressiveness of prostate cancer later."

Previous research in this area often focused on the effect of alcohol intake on overall prostate cancer risk. Because many cases of prostate cancer are indolent, the researchers analyzed whether alcohol consumption during puberty and midlife are associated with high-grade prostate cancer in adulthood.

High-Grade Prostate Cancer Risk

Allott and colleagues evaluated data from 650 men undergoing a prostate biopsy at the Durham Veterans Affairs Medical Center between January 2007 and January 2018. These veterans had no prior history of prostate cancer, and their ages ranged from 49 to 89 years old. The population was racially diverse; 54 percent of patients were non-white. Men completed questionnaires which assessed the average number of alcoholic drinks consumed weekly during each decade of life to determine age-specific and cumulative lifetime alcohol intake.

Following multivariable analysis, the researchers found that heavy alcohol intake at ages 15-19 was not associated with overall prostate cancer; however, consumption of at least seven drinks per week during this age was associated with 3.2 times the odds of high-grade prostate cancer compared with non-drinkers. Similar associations were observed among those who consumed at least seven alcoholic drinks per week at ages 20-29, 30-39, and 40-49, resulting in 3.14, 3.09, and 3.64 times the odds of high-grade prostate cancer, respectively, compared with non-drinkers. However, current alcohol consumption was not significantly associated with high-grade prostate cancer.

Lifetime Alcohol Consumption

The authors also evaluated the association between cumulative lifetime alcohol consumption and prostate cancer diagnosis. Compared with men in the lowest tertile of lifetime alcohol intake, those in the upper tertile had 3.2 times the odds of being diagnosed with high-grade prostate cancer at biopsy.

"Our results may explain why previous evidence linking alcohol intake and prostate cancer has been somewhat mixed," noted Allott. "It's possible that the effect of alcohol comes from a lifetime intake, or from intake earlier in life rather than alcohol patterns around the time of diagnosis of prostate cancer."

Is Smoking a Factor?

Limitations of the study include a reliance on self-reported data, which could be subject to recall bias. Furthermore, because heavy drinkers within the study were often heavy smokers, Allott noted that despite adjusting their model for smoking, residual confounding may exist, and that the sample size was not large enough to explore this association further.

Additionally, those who heavily consumed alcohol early in life typically continued to drink heavily throughout their entire life; as such, the researchers could not definitively separate the potential effects of early-life exposure of alcohol from cumulative lifetime exposure.

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August 22, 2018

Illicit Drug Use Higher Than HHS Estimates

America's drug problem may be even worse than officials realize. And illicit drugs are consumed at a higher rate during celebratory events. Those are just two of the conclusions scientists have drawn from recent studies of drug residues in sewage.

The researchers was presenedt at the 256th National Meeting & Exposition of the American Chemical Society in August 2018.

In the U.S., more than 28 million people aged 12 or older used an illicit drug in 2016, including 12 million who misused opioids, according to estimates from the U.S. Department of Health and Human Services (HHS). Collecting such data has some challenges, however.

Faster, Inexpensive Research

"The conventional approach to assess community drug usage in the U.S. takes months or years," Bikram Subedi, Ph.D., says. It's also costly, and researchers have had to rely on drug-related crime statistics, overdose/toxicology reports and the public's responses to surveys, which could well underreport use, he adds.

As a faster, inexpensive alternative, Subedi's team at Murray State University uses "sewage epidemiology," a technique for analyzing wastewater. Subedi, the project's lead investigator, says this method gleans nearly real-time data on drug consumption in local communities. The testing shows that consumption of some drugs is far more widespread than HHS estimates suggest. It also confirms the intuitive assumption that drug use rises during celebrations.

2 Western Kentucky Communities

In a prior study, Subedi analyzed drug use in New York. His recent studies were carried out in Kentucky, where undergraduate Katelyn Foppe and others in Subedi's lab assessed whether special events, such as the Fourth of July or the 2017 solar eclipse, would impact drug use in two towns. They also wanted to know if the effects would differ in the towns, which are nearly the same size, just 50 miles apart and governed by the same rules and regulations.

The researchers collected samples at each town's sewage treatment plant. After returning to the lab, the team filtered and extracted the samples and then analyzed them with high-performance liquid chromatography and mass spectrometry. "The results showed that consumption of drugs like methamphetamine, cocaine and THC -- the main active ingredient in marijuana -- was significantly higher during festive events," Subedi says. "But the profile and rate of consumption was significantly different in the two towns." He plans to do further studies to explore the reasons for that difference.

Meth Use 4 Times Higher Than Thought

Calculations based on the tests revealed levels of methamphetamine consumption that are among the highest ever reported in the U.S. In addition, the percentage of the population using amphetamine and methamphetamine was two- to four-fold higher than HHS estimates, according to the researchers. The samples also showed very high consumption of opiates such as hydrocodone, oxycodone, Percocet and morphine, Subedi says. He notes that Kentucky is in a region infested with illegal meth labs and burdened with extremely high opiate prescription rates.

Although sewage epidemiology is widely applied in Europe, it has been underused in the U.S., Subedi notes. He uses a state-of-the-art analytical method -- isotope dilution mass spectrometry -- that incorporates internal standards, or isotopically labeled versions of drug molecules in which selective hydrogen atom(s) are replaced with heavier deuterium. Adding a small amount of these labeled molecules during an analysis allows the researchers to confirm the identity and concentration of drugs they suspect are in a given wastewater sample.

Plans to Test Nationwide

Subedi's current sample-collection method can't zero in on the specific sites of illicit drug use within a community. So the team plans to move upstream, collecting sewage samples from the suspected individual sites before they're commingled at the wastewater treatment facility.

This refinement would reveal whether drug use is homogeneous throughout a particular town, or if there are hotspots of consumption, such as a particular neighborhood, hospital or school. Subedi also wants to track population data so he can correct for an influx of tourists during a festive event, for example, and to expand sewage testing nationwide.

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August 13, 2018

Alcohol Can Help Beat Cocaine Addiction

Exercise can help prevent relapses into cocaine addiction, according to new research led by the University at Buffalo's Panayotis (Peter) Thanos, PhD.

"Cocaine addiction is often characterized by cycles of recovery and relapse, with stress and negative emotions, often caused by withdrawal itself, among the major causes of relapse," says Thanos, senior research scientist in the UB Research Institute on Addictions and Department of Pharmacology and Toxicology.

Decreases Cocaine-Seeking Behavior

Using animal models, Thanos found that regular aerobic exercise (one hour on a treadmill, five times a week) decreased stress-induced cocaine-seeking behavior. Exercise also altered behavioral and physiological responses to stress.

Individuals who are addicted to cocaine have altered neural, behavioral and physiological responses to stress. Recent research by Thanos demonstrated how exercise can alter the brain's mesolimbic dopamine pathway, which is linked to the rewarding and reinforcing properties of drugs such as cocaine.

In addition, exercise has been shown to reduce stress hormones and elevate mood, which could assist in alleviating anxiety and negative emotions associated with withdrawal.

Aerobic Exercise Helps

Studies already have shown that aerobic exercise (also known as "cardio") is an effective strategy against many physical health problems, including heart disease, diabetes and arthritis, along with certain mental health issues, such as stress, anxiety and depression.

"Our results suggest that regular aerobic exercise could be a useful strategy for relapse prevention, as part of a comprehensive treatment program for recovering cocaine abusers," Thanos says. "Further research is necessary to see if these results also hold true for other addictive drugs."

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August 09, 2018

Higher Alcohol Taxes Can Reduce Harm

Increasing taxes on alcohol is one of the most cost-effective methods of reducing the harms caused by alcohol consumption, according to research in the new issue of the Journal of Studies on Alcohol and Drugs.

Restrictions on alcohol advertising and hours of sale are also a "best buy" when it comes to reducing hazardous and harmful alcohol use and, by extension, improving overall health in the population.

Most Cost-Effective Method

"Tax increases may not sound the most attractive of policy options but are the single most cost-effective way of diminishing demand and reining back consumption," says lead researcher Dan Chisholm, Ph.D., of the Department of Mental Health and Substance Abuse at the World Health Organization in Geneva, Switzerland.

In the study, researchers from the World Health Organization and one of its academic collaborating centers used a statistical model to determine which of five alcohol control strategies could be a cost-effective public health policy to reduce deaths and harms from alcohol consumption. Previous research has indicated that more than 5 percent of deaths worldwide and over 4 percent of diseases are directly related to alcohol.

A 50 percent hike in alcohol excise taxes--that is, taxes worked into the price of the product and that the consumer might not "see"--would cost less than the equivalent of USD$100 for each healthy year of life gained in the overall population and would add 500 healthy years of life for every 1 million people.

A Feasible Strategy

To put that tax increase in perspective, it might represent mere pennies per drink. According to a study in the January issue of the journal, state excise taxes in America average only three cents per 12 oz. beer or 5 oz. glass of wine and only five cents for a drink with 1.5 oz. of hard liquor.

"Current rates of excise taxes on alcohol vary considerably between jurisdictions but can be set very low," Chisholm says, "for example because of low awareness of the risks that alcohol consumption can pose to health or because of strong advocacy from economic operators."

But increasing these rates is "an ambitious but feasible strategy," according to the study, and this change in public policy "would bring excise taxes for alcoholic beverages more in line with those imposed on tobacco products."

Other Methods Available

Restricting hours of operation for off-premise alcohol retailers or implementing and enforcing strong restrictions/bans on alcohol advertising (on the Internet, radio, television, and billboards) each would also cost less than $100 per healthy year of life gained and would add up to 350 healthy life years for every 1 million people in the population.

Stronger enforcement of blood alcohol concentration laws by increasing the number of sobriety checkpoints would be a somewhat less cost-effective policy: Their model showed it would cost up to $3,000 per healthy year of life saved and would add fewer than 100 years of healthy life per 1 million people. The higher cost would be the result of more time invested by police and the equipment required at checkpoints.

Chisholm and colleagues found that wider use of brief alcohol-problem screening and intervention performed by primary care doctors would generate up to 1,000 years of healthy life per 1 million people, but at a price of up to $1,434 per year of healthy life gained.

Benefits May Be Underestimated

The study used data from 16 countries, including upper middle- and high-income countries (such as the United States, Germany, Japan, and China) as well as low- and lower middle-income countries (such as Guatemala, India, Ukraine, and Vietnam).

The report's authors note that they likely underestimated the benefits of improved alcohol control strategies. Their study did not look at effects such as reduced property damage or better productivity at work, among other likely benefits of less overall alcohol consumption in the population.

Nonetheless, not everyone will necessarily think that less alcohol consumption is good policy. "Implementation of these effective public health strategies is actively fought by the alcohol industry, often with threats of lost jobs and/or revenue for countries," the authors write.

In the end, the authors hope their research will "guide decision makers toward a more rational and targeted use of available resources . . . for addressing the substantial and still growing burden of disease attributable to alcohol use."

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