Showing papers in "Alcohol and Alcoholism in 2006"

The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta-analytic review.

Abstract: Aims : (1) To examine whether or not motivational interviewing (MI) is more efficacious than no intervention in reducing alcohol consumption; (2) to examine whether or not MI is as efficacious as other interventions. Method : A literature search followed by a meta-analytic review of randomized control trials of MI interventions. Aggregated between-group effect sizes and confidence intervals were calculated for each study. Results : Literature search revealed 22 relevant studies, of which nine compared brief MI with no treatment, and met methodological criteria for inclusion. In these, the aggregate effect size was 0.18 (95% C.I. 0.07, 0.29), but was greater 0.60 (95% C.I. 0.36, 0.83) when, in a post-hoc analysis, the follow-up period was three months or less. Its efficacy also increased when dependent drinkers were excluded. There were nine studies meeting methodological criteria for inclusion which compared brief MI with another treatment (one of a diverse set of interventions), yielding an aggregate effect size of 0.43(95% C.I. 0.17, 0.70). The literature review pointed to several factors which may influence MI's long-term efficacy effectiveness of MI. Conclusions : Brief MI is effective. Future studies should focus on possible predictors of efficacy such as gender, age, employment status, marital status, mental health, initial expectations, readiness to change, and whether the population is drawn from treatment-seeking or non-treatment-seeking populations. Also, the components of MI should be compared to determine which are most responsible for maintaining long-term changes. ( Received 11 July 2005; first review notified 24 July 2005; in revised form 13 February 2006; accepted 16 February 2006)

Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action 'gender, culture and alcohol problems: a multi-national study'

Abstract: AIMS: We investigated the presence of social inequalities of alcohol use and misuse using educational attainment as an indicator of socio-economic status in 15 countries: Sweden, Norway, Finland, Germany, The Netherlands, Switzerland, Hungary, the Czech Republic, Israel, Brazil, and Mexico. METHODS: Study surveys were independently conducted and the data centrally analysed. Most samples were national. Survey modes and sample sizes varied. The age range was restricted to between 25 and 59 years of age. Socio-economic status was measured by educational level. Multiple logistic regressions were employed to calculate age-adjusted odds ratios for men and women in each country by educational level for current drinking status, heavy drinking (>/=20 g ethanol per day for women, >/=30 g a day for men), heavy episodic (binge) drinking, and alcohol-related problems (using AUDIT). RESULTS: Men and women demonstrated similar patterns in inequalities with regard to current drinking status within a country. In Germany, The Netherlands, France, Switzerland, and Austria higher educated women were most likely to drink heavily, while among men the lower educated were more at risk in most countries. For heavy episodic drinking, almost no significant differences were evident among women, but for men a social gradient was observable with lower educated being more at risk in several countries. Among five countries with data from the AUDIT, men of lower education in Finland, Czech Republic, and Hungary had higher risks to report problems. Nordic countries shared a common pattern in social inequalities as did two Latin American countries, while a mixed picture was observed for middle European countries. Social inequalities in the two Latin American countries display a pattern emerging in other research on developing countries: namely that those in the higher educated groups are more likely to consume alcohol in a risky manner. CONCLUSIONS: Patterns in the distribution of social inequalities are not universal. Social inequalities in alcohol use differ by gender according to alcohol measure used and differ also across groups of countries. These variations should be taken into account when formulating international and cross-cultural alcohol policies. Language: en

The natural history and pathophysiology of wernicke's encephalopathy and korsakoff's psychosis

Abstract: Aims: To identify the early clinical indications of thiamine deficiency and to understand the factors involved in the development of the amnesic state in alcohol-dependent individuals with thiamine deficiency. It is hoped that this will highlight the need for clinicians to treat alcohol-dependent patients prophylactically with parenteral thiamine and thus prevent the development of Korsakoff's Psychosis (KP). Method: We have reviewed the natural history and pathophysiology of Wernicke's Encephalopathy (WE) in both human and animal studies together with any contributory factors that may predispose the individual to thiamine defi- ciency. A further understanding of these problems is provided by recent studies into the metabolic consequences of thiamine deficiency and alcohol misuse. Conclusions:Where WE is due to thiamine deficiency alone (i.e. in the absence of alcohol misuse) KP rarely super- venes following thiamine replacement therapy. Successful treatment or prophylaxis of WE in alcohol dependence probably depends on a number of inter-related issues and is not simply a matter of early and adequate thiamine treatment. If sufficient alcohol-related neuro- toxicity has occurred by the time of diagnosis, then this may be the more important or limiting factor with respect to the long-term out- come. This possible obstacle to complete recovery should not prevent every attempt being made to provide the patient with optimum brain thiamine replacement.

Drinking patterns and their gender differences in Europe.

Abstract: Aims: To compare drinking habits and to examine differences between drinking cultures in different regions and countries in Europe; to examine gender differences in drinking habits and to compare them over countries. Methods: Data consisted of independently conducted, centrally analysed surveys in the general population aged 20-64 years in 14 European countries. Central measures were abstention, frequency and volume of drinking overall and by beverage type, amounts drunk per drinking day, and heavy episodic drinking. Results: There were clear gender differences in all drinking measures, except for wine drinking. Differences between genders were often smaller than average in northern Europe. Gender ratios did not show systematic changes by age, with the exception that young men and women differed less than older men and women in the frequency of heavy episodic drinking. The results on beverage preferences indicate that the distinction among wine/beer/spirits cultures have implicitly been based on male drinking. Our expectation was for more daily light drinking integrated in everyday life in the Mediterranean countries, more heavy episodic drinking associated with weekends and celebrations in the North, with the traditional beer countries somewhere in between. The differences observed were usually in the direction expected. However, no country represented an ideal type of drinking culture, i.e. drinking for 'mood-changing effects' only or for 'nutritional purposes' only; all countries were mixtures of these two extremes. Conclusions: There were clear and consistent gender differences in all countries, while the differences in drinking between countries and regions were not as obvious.

PHOSPHATIDYLETHANOL (PEth) CONCENTRATIONS IN BLOOD ARE CORRELATED TO REPORTED ALCOHOL INTAKE IN ALCOHOL-DEPENDENT PATIENTS

Abstract: Aims: Phosphatidylethanol (PEth) is an abnormal phospholipid formed only in the presence of ethanol by the enzyme phospholipase D. PEth in blood is a promising new marker for ethanol abuse. None of the biological markers used at the present time is sensitive and specific enough for the diagnosis of alcoholism. Methods: The most frequently used alcohol markers (carbohyd- rate deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and mean corpuscular volume (MCV)) were studied together with PEth in actively drinking alcohol-dependent patients (inpatients and outpatients), with regard to correlation to ethanol intake and diagnostic sensitivity of the markers. The relation between the markers was also studied. Results: PEth, CDT, and GGT correlated to ethanol intake, with the strongest correlation found for PEth. The diagnostic sensitivity for PEth was 99%, and for other markers it varied between 40 and 77%. Only when CDT was combined with GGT was a sensitivity of 94% reached. PEth correlated to CDT and GGT but not to MCV. CDT did not correlate to GGT or MCV. Conclusions: Blood concentrations of PEth are highly correlated to ethanol intake, and the present results indicate that its diagnostic sensitivity is higher than that for previously established alcohol markers.

Predicting binge-drinking behaviour using an extended tpb: examining the impact of anticipated regret and descriptive norms

Abstract: Aims: To investigate the utility of an extended Theory of Planned Behaviour (TPB), including descriptive norms and anticipated regret, in predicting binge-drinking intentions and behaviour. Methods: A total of 178 undergraduates completed a ques- tionnaire containing measures of TPB variables, descriptive norms, anticipated regret, and previous binge-drinking behaviour. One week later, 104 students completed a measure of binge-drinking behaviour. Results: Hierarchical regression demonstrated that attitudes (beta = 0.30, P < 0.001) and anticipated regret (beta = 0.47, P < 0.001) were significant predictors of intentions, with the final equation accounting for 58% of the variance. Hierarchial regression found that intentions (beta = -0.21, P < 0.05) and previous binge- drinking behaviour (beta = 0.36, P < 0.01) predicted current drinking behaviour, accounting for 33% of the variance. Conclusions: The study suggests that modifying attitudes and inducing regret may be effective strategies for reducing binge-drinking intentions among undergraduates, which should reduce subsequent binge-drinking behaviour.

The association between alcohol misuse and suicidal behaviour

Abstract: Aims: Despite recent small reductions in overall suicide rates, rates among those aged 25-44 have remained high. The aim of this paper was to examine the evidence for a link between alcohol misuse/consumption and suicidal behaviour,explore the reasons for this association, and consider the implications for reducing rates of suicidal behaviour. Methods: A medline search was performed to find relevant research evidence. Results: There is evidence to suggest alcohol misuse predisposes to suicidal behaviour through its depressogenic effects and promotion of adverse life events, and both behaviours may share a common genetic predisposition. Acute alcohol use can also precipitate suicidal behaviours through induction of negative affect and impairment of problem-solving skills, as well as aggravation of impulsive personality traits, possibly through effects on serotonergic neurotransmission. Conclusions: Effective interventions for problem drinking may help reduce suicide rates. At a public health level, reducing overall alcohol consumption may be beneficial, and the measures shown to be most effective in this regard are those that aim to restrict availability of alcohol. drawn between suicide attempts and completed suicide, as the characteristics of the two populations can be quite differ- ent, particularly in respect to gender. Therefore, this review will examine both types of suicidal behaviour, and will exam- ine risk factors as predisposing or precipitating, even though the distinction between these can be sometimes arbitrary. For instance, on an epidemiological level, levels of alcohol con- sumption have frequently been shown to be associated with the suicide rate (Stack, 2000), but this association, if causal, can be seen as both predisposing and precipitating. This review takes a broader outlook than most, focussing not just on the evidence for a link between alcohol misuse and suicidal behaviour, but also possible clinical or biological factors that may mediate this link, and the implications of this evidence for suicide prevention.

The role of alcohol expectancy and drinking refusal self-efficacy beliefs in university student drinking

Abstract: Aims: University student alcohol misuse is a considerable problem. Alcohol expectancy research has contributed significantly to our understanding of problem drinking in young adults. Most of this research has investigated positive expectancy alone. The current study utilized two measures of alcohol expectancy, the alcohol expectancy questionnaire (AEQ) and the drinking expectancy profile [consisting of the drinking expectancy questionnaire (DEQ) and the drinking refusal self-efficacy questionnaire] to predict severity of alcohol dependence, frequency of drinking, and the quantity of alcohol consumed per occasion. Methods: Measures of drinking behaviour and alcohol expectancy were completed by 174 undergraduate university students. Results: Positive alcohol expectancy factors accounted for significant variance in all three drinking indices, with the DEQ adding additional variance to AEQ scores on frequency and severity of alcohol dependence indices. Negative expectancy did not add incremental variance to the prediction of drinking behaviour in this sample. Drinking refusal self-efficacy and dependence beliefs added additional variance over positive and negative expectancies in the prediction of all three drinking parameters. Conclusions: Positive expectancy and drinking refusal self-efficacy were strongly related to university student drinking. The incorporation of expectancy as a means of informing prevention approaches in tertiary education shows promise.

Acute in vivo effect of ethanol (binge drinking) on histone H3 modifications in rat tissues.

Abstract: Aims: To investigate the effect of acute in vivo administration of ethanol on acetylation or methylation of histone H3 at lysine9 in different tissues in rat. Methods: Ethanol was injected into the stomach of Sprague-Dawley rats (8-weeks-old) using blunt tipped needle. The rats were divided into three groups based on ethanol exposure times (1, 3, and 12 h). Each group was compared with water-injected control group. The tissues from 14 different organs were removed. We essentially used similar type of protocol, tissue homogenization method, and sucrose density gradient centrifugation for isolation of nuclei with only minor modifications for some organs. Histone was isolated from the nuclei using acid extraction method. Acetylation of histone H3 at lysine9 (Ac-H3-lys9) and methylation of histone H3 at lysine9 (Me-H3-lys9) were analysed by western blotting. Results: Effect of ethanol on Ac-H3-lys9 was investigated in 11 out of 14 rat tissues. In liver, we observed an increase in Ac-H3-lys9 with maximal increase of 6-fold after 12 h exposure. Lung also showed 3-fold increase. In spleen, ethanol-induced Ac-H3-lys9 in all three ethanol-treated groups with similar increase (1.5- to 1.6-fold). Testes showed significant increase (3-fold increase) of Ac-H3-lys9 only at 1 h ethanol exposure. Ethanol had no affect on Ac-H3-lys9 in other tissues: kidney, brain, heart, stomach, colorectum, pancreas, and vessels. Ethanol had little effect on Me-H3-lys9 in all rat tissues examined. Conclusions: After in vivo administration of ethanol, analogous to binge drinking condition, the acetylations of H3-lys9 in rat tissues are not universal but tissue-specific events with different patterns of responses. Ac-H3-Lys9 in liver, lung, and spleen were significantly affected and it was demonstrated that ethanol causes this epigenetic alteration in rat tissues selectively.

The influence of societal level factors on men's and women's alcohol consumption and alcohol problems.

Abstract: Aims: To identify the pattern of gender differences in drinking across societies, and to its association with other societal characteristics. Methods: The aggregated results of GENACIS project surveys in 29 countries were examined and were compared with other characteristics of these societies. Results: In all the participating societies men's drinking was more prevalent and heavier than women's drinking. Differences between countries in the gender gap in drinking were strongly associated with women's position in society, as well as with modernization. Similar results were obtained for indicators of alcohol's adverse consequences. Conclusions: Gender differences should be studied not only as individual behaviours, but also as societal traits, associated with other characteristics of the social system.

Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers.

Abstract: Aims: A combined index based on γ-glutamyltransferase (GGT) and carbohydrate-deficient transferrin (CDT) measurements (GGT–CDT) has been recently suggested to improve the detection of excessive ethanol consumption. The aim of this work was to compare GGT–CDT with the conventional markers of alcohol abuse in individuals with a wide variety of alcohol consumption. Methods: A cross-sectional and follow-up analysis was conducted in a sample of 165 heavy drinkers, consuming 40–540 g of ethanol per day, and 86 reference individuals who were either moderate drinkers ( n = 51) or abstainers ( n = 35). Results: GGT–CDT (5.35 ± 1.08) in the heavy drinkers was significantly higher than in the reference individuals (3.30 ± 0.37). The sensitivity of GGT–CDT (90%) in correctly classifying heavy drinkers exceeded that of CDT (63%), GGT (58%), mean corpuscular volume (MCV) (45%), aspartate aminotransferase (AST) (47%), and alanine aminotransferase (ALT) (50%), being also essentially similar for alcoholics with (93%) or without (88%) liver disease. When comparing the data using either moderate drinkers or abstainers as reference population, the sensitivity of GGT–CDT, CDT, and ALT remained unchanged whereas the sensitivity of GGT, MCV, and AST was found to show variation. Conclusions: GGT–CDT improves the sensitivity of detecting excessive ethanol consumption as compared with the traditional markers of ethanol consumption. These findings should be considered in the assessment of patients with alcohol use disorders. ( Received 6 January 2006; first review notified 19 April 2006; in revised form 5 May 2006; accepted 19 May 2006)

Protective effect of resveratrol on ethanol-induced lipid peroxidation in rats.

Abstract: Aim: Chronic ethanol treatment induces an increase in oxidative stress. As polyphenolic compounds are potent antioxi- dants, we aimed to examine whether dietary supplementation of resveratrol may attenuate lipid peroxidation, the major end-point of oxidative damage resulting from chronic ethanol administration. Method: Three groups of male Wistar rats were used. The first group served as control and received a daily intraperitoneal injection of 0.9% saline. The second group of rats was daily injected with 35% ethanol at 3 g/kg body weight. The third group was given the same dose of ethanol and supplemented with resveratrol (5 g/kg) in the standard diet. Malondialdehyde (MDA), an indicator of oxidative stress, was measured in the liver, heart, brain, and testis. Results: At the end of a 6 weeks treatment period, MDA levels were significantly increased by 51.5, 53.7, 72.7, and 40.5% in the liver, heart, brain, and testis, respectively. However, when ethanol treated rats were given resveratrol the increase in MDA levels was significantly reduced in all organs to nearly those of control rats. Conclusion: Resveratrol is able to inhibit the ethanol-induced lipid peroxidation and have protective effect against oxidative injury.

Screening and brief intervention online for college students: the ihealth study.

Abstract: Aims: To test the feasibility of online alcohol screening and brief intervention (BI) by comparing (i) two approaches to inviting all students to be screened, and (ii) a minimal versus a more extensive BI. Methods: Freshmen students at one university were randomized to receive one of two types of email invitations to an online anonymous: (i) general health assessment, or (ii) alcohol-specific assessment. All were linked to the same alcohol screening survey. Those with unhealthy alcohol use (AUDIT >8) were randomly assigned to minimal or more extensive online alcohol BI. Results: In both invitation groups (4008 students), 55% of students completed the online screening. Overall, 37% of men and 26% of women had unhealthy alcohol use. Compared to mini- mal BI, more extensive BI was associated with intention to seek help among men and with a greater increase in readiness to change among women. One month after BI, 75% of students completed another assessment, 33% of women and 15% of men with unhealthy alcohol use at baseline no longer had unhealthy alcohol use. There were no significant differences on drinking measures by BI random- ization group. Conclusions: Over half of an entire freshman class of college students were reached by email and completed alcohol screening and brief intervention. Even an alcohol-specific invitation did not deter students. Although brief interventions that differed had some gender specific effects on readiness to change and intention, in general, unhealthy alcohol use decreased after brief interven- tion. Web screening and brief intervention show promise for addressing unhealthy alcohol use by college students.

Suppression of symptoms of alcohol dependence and craving using high-dose baclofen

Abstract: Aims: To further test whether the baclofen-induced suppression of motivation to consume alcohol in animals could be transposed to humans. Methods: A patient who had neither tolerated nor benefited from other alcohol treatment modalities was put on trial with baclofen on a dosage up to 140 mg/day. Results: The patient reported dramatic reduction in cravings for and preoccupation with alcohol. Conclusions: High-dose baclofen therapy was associated with complete and prolonged suppression of symptoms and consequences of alcohol-dependence.

Liver transplantation for alcoholic liver disease: a systematic review of psychosocial selection criteria.

Abstract: Aims: To examine the evidence base for psychosocial selection criteria for liver transplant candidates with alcoholic liver disease. Method: Systematic review using three electronic databases supplemented by hand searches. Results: Out of 96 published studies, 22 were included. All but one were cohort design, most were retrospective, single centre, and small sample. Methodology varied considerably, such that meta-analysis was not feasible. Conclusions: Social stability, no close relatives with an alcohol problem, older age, no repeated alcohol-treatment failures, good compliance with medical care, no current polydrug misuse, and no co-existing severe mental disorder have all been associated with future abstinence in more studies than not, in those that examined these variables. Duration of preoperative abstinence was a poor predictor. We recommend that, if predicting future abstinence is considered necessary by transplant teams, a standardized approach is agreed and deployed amongst transplant units, then audited and reviewed. ( Received 13 October 2005; first review notified 8 November 2005; in revised form 15 March 2006; accepted 25 March 2006)

Fenugreek (Trigonella Foenum Graecum) seed extract prevents ethanol-induced toxicity and apoptosis in chang liver cells

Abstract: The protective effect of a polyphenolic extract of fenugreek seeds (FPEt) against ethanol (EtOH)-induced toxicity was investigated in human Chang liver cells. Cells were incubated with either 30 mM EtOH alone or together in the presence of seed extract for 24 h. Assays were performed in treated cells to evaluate the ability of seeds to prevent the toxic effects of EtOH. EtOH treatment suppressed the growth of Chang liver cells and induced cytotoxicity, oxygen radical formation and mitochondrial dysfunction. Reduced glutathione (GSH) concentration was decreased significantly (P < 0.05) while oxidized glutathione (GSSG) concentration was signific- antly elevated in EtOH-treated cells as compared with normal cells. Incubation of FPEt along with EtOH significantly increased cell viability in a dose-dependent manner, caused a reduction in lactate dehydrogenase leakage and normalized GSH/GSSG ratio. The extract dose-dependently reduced thiobarbituric acid reactive substances formation. Apoptosis was observed in EtOH-treated cells while FPEt reduced apoptosis by decreasing the accumulation of sub-G1 phase cells. The cytoprotective effects of FPEt were compar- able with those of a positive control silymarin, a known hepatoprotective agent. The findings suggest that the polyphenolic compounds of fenugreek seeds can be considered cytoprotective during EtOH-induced liver damage. protective role of the seeds in detail, we evaluated the effect of the polyphenolic extract of the seeds on EtOH-induced cytotoxicity in Chang liver cells and compared it with a stand- ard hepatoprotective drug silymarin. We evaluated this by measuring cell viability, 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) metabolism, lactate dehydrogenase (LDH) leakage, the ratio of reduced gluta- thione and oxidized glutathione (GSH/GSSG), thiobarbituric acid reactive substances (TBARS) formation, intracellular reactive oxygen species (ROS) production and apoptosis in Chang liver cells exposed to EtOH in the presence and absence of FPEt and or silymarin.

The glycine reuptake inhibitor Org 25935 decreases ethanol intake and preference in male wistar rats.

Abstract: Previous findings from our group indicate that accumbal glycine receptors (GlyRs) are involved in mediating the dopamine (DA) activating effects of ethanol (EtOH), and that administration of glycine locally into the nucleus accumbens (nAc) reduces EtOH consumption in EtOH high-preferring rats. Aims: The present study examines the influence of a systemically administered glycine reuptake inhibitor, Org 25935, on EtOH preference and intake, in male Wistar rats with an EtOH preference >60% (during continuous access to a bottle of EtOH, 6% v/v, and a bottle of water), called EP>60 rats, as well as in animals with an EtOH preference 60 and EP<60 rats were limited to drink 2.5 h/day. Org 25935 or vehicle was administered intraperitoneally 40 min before the rats were presented to a choice of drinking EtOH or water. Results: Org 25935 decreased EtOH intake and EtOH preference, as compared with vehicle, whereas water intake was unaffected. This effect was dose-dependent, developed gradually and was sustained for up to 40 days, also after introduction of an alcohol deprivation period. Conclusion: It is sug- gested that Org 25935, and possibly also other GlyT1 inhibitors, can represent a new pharmacological treatment principle for alcohol dependence or abuse.

Introduction to special issue 'gender, culture and alcohol problems: a multi-national study'

Abstract: This paper provides an introduction to a series of articles reporting results from the EU concerted action ''Gender, Culture and Alcohol Problems: A Multi-national Study'' which examined differences in drinking among women and men in 13 European and two non-European countries. The gender gap in alcohol drinking is one of the few universal gender differences in human social behavior. However, the size of these differences varies greatly from one society to another. The papers in this issue examine, across countries, (1) men's and women's drinking patterns, (2) the prevalence of men's and women's experience of alcohol-related problems, (3) gender differences in social inequalities in alcohol use and abuse, (4) gender differences in the influence of combinations of social roles on heavy alcohol use, and (5) how societal-level factors predict women's and men's alcohol use and problems on a regional and global level. Country surveys were independently conducted and then centralized at one institution for further data standardization and pro- cessing. Several results indicated that the greater the societal gender equality in a country, the smaller the gender differences in drinking behavior. In most analyses the smallest gender differences in drinking behaviour were found in Nordic countries, followed by western and central European countries, with the largest gender differences in countries with developing economies.

Predictors of relapse to harmful alcohol after orthotopic liver transplantation

Abstract: Background: End-stage alcoholic liver disease (ALD) is a common indication for liver transplantation. Outcomes may be limited by return to harmful drinking. Previous studies have identified few predictors of drinking relapse. Aim: This study examined novel postulated predictors of relapse to drinking. Method: The case notes of all patients transplanted for ALD at the Royal Prince Alfred Hospital from 1987–2004 were reviewed. Pre-transplant characteristics were rated by a psychiatrist independent of the transplant team, blind to the outcome. Outcomes were rated by a second independent alcohol treatment specialist also blind to the pre-transplant ratings. Results: Of 100 patients, 6 died before discharge from hospital, 4 had <6 months follow-up, 18 relapsed to harmful drinking, 10 drank below harmful levels, and 62 remained abstinent after a mean of 5.6 years follow-up. Univariate analyses identified six potential pre-transplant predictors of return to harmful drinking. These were a diagnosis of mental illness (of which all cases were of depression), the lack of a stable partner, grams per day consumed in the years before assessment for transplant, reliance on ‘family or friends’ for post-transplant support, tobacco consumption at time of assessment, and lack of insight into the alcohol aetiology. Duration of pre-transplant abstinence and social class by occupation did not predict relapse. A multivariate model based on the above characteristics correctly predicted 89% of the outcomes. Conclusion: A model based on readily defined behaviours and psychosocial factors predicted relapse to harmful drinking after transplant for ALD. This model may improve assessment and post-transplant management of patients with advanced ALD. ( Received 16 September 2005; first review notified 12 November 2005; in revised form 28 November 2005; accepted 29 November 2005)

The treatment of patients at risk of developing wernicke's encephalopathy in the community

Abstract: Aim: To review the process of identifying alcohol-dependent patients at risk of developing Wernicke's encephalopathy (WE) in the community, and prophylactic treatment options. Methods: Non-systematic literature review of the diagnosis of thiamine deficiency and of its treatment in the community. The role of supplementation of beer and bread with thiamine was evaluated. Results: The diagnosis of thiamine deficiency is not always made, and treatment apparently may sometimes be inadequate. Conclusions: Alcohol-dependent patients in the community who are at risk of developing WE should be given thiamine 250 mg, intramuscularly, daily for 3–5 days as part of a community detoxification programme. Further work is essential to determine the optimum dose of thiamine required to prevent permanent brain damage (Korsakoff's Psychosis). Neurotoxicity, due to the metabolism of excessive alcohol in patients with chronic and severe alcohol dependence, must be considered as an important factor in determining the long-term outcome of treatment. ( Received 21 December 2004; first review notified 16 February 2005; in revised form 1 November 2005; accepted 2 November 2005)

The role of genetic polymorphisms in alcoholic liver disease.

Abstract: Chronic alcohol consumption is a major cause of liver cirrhosis which, however, develops in only a minority of heavy drinkers. Evidence from twin studies indicates that genetic factors account for at least 50% of individual susceptibility. The contribution of genetic factors to the development of diseases may be investigated either by means of animal experiments, through linkage studies in families of affected patients, or population based case-control studies. With regard to the latter, single nucleotide polymorphisms of genes involved in the degradation of alcohol, antioxidant defense, necroinflammation, and formation and degradation of extracellular matrix are attractive candidates for studying genotype-phenotype associations. However, many associations in early studies were found to be spurious and could not be confirmed in stringently designed investigations. Therefore, future genotype-phenotype studies in alcoholic liver disease should meet certain requirements in order to avoid pure chance observations due to a lack of power, false functional interpretation, and insufficient statistical evaluation.

Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations.

Abstract: Aims: Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations (MCOs). Methods: A pre-post, quasi-experimental, multi-site evaluation conducted at 15 clinic sites within five MCO settings. At-risk drinkers (N = 1329) received either: (i) brief intervention delivered by licensed practitioners; or (ii) brief intervention delivered by mid-level professional specialists (nurses); or (iii) usual care (comparison condition). Clinics were randomly assigned to three study conditions. Data were collected on the cost of screening and brief intervention. Follow-up interviews were conducted at 3 and 12 months. Results: Participants in all three study conditions were drinking significantly less at 3-month follow-up, but the decline was significantly greater in the two intervention groups than in the control group. There were no significant differences between the two intervention conditions. Of the patients in the intervention conditions 60% reduced their alcohol consumption by =1 drink per week, compared with 53% of those in the control condition. No differences were found on a measure of the quality of life. Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up. Average incremental costs of the interventions were $4.16 USD per patient using licensed practitioners and $2.82 USD using mid-level specialists. Conclusion: Alcohol screening and brief intervention when implemented in managed care organizations produces modest, statistically significant reductions in at-risk drinking. Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost.

Drinking and motivations to drink among adolescent children of parents with alcohol problems.

Abstract: Aims: To study the influences of parental alcohol problems on adolescents' alcohol consumption and motivations to drink alcohol. Methods: A community sample of 1744 adolescents from schools in South Wales completed the 6-item Children of Alcoholics Screening Test, Drinking Motives Questionnaire, and survey measures of alcohol consumption. Results: Children of parents with alcohol problems constituted almost one-fifth of the sample group and were found to drink more frequently, more heavily, and more often alone than children of parents without alcohol problems. Parental alcohol problems were also related to internal motives to drink (e.g. coping) in their adolescent children. Across the entire sample, internal motives to drink interacted with parental alcohol problems in predicting alcohol consumption and drinking frequency. Conclusion: Parental alcohol problems appeared to co-exist with an asocial pattern of alcohol consumption in adolescents that involves drinking alone and drinking to feel intoxicated or to forget about problems. In addition to the external, social motives to drink, which are shared by most adolescents, nearly one in five of the adolescents studied reported salient internal motives to drink that tended to coexist with alcohol problems in their parents.

Behavioural aspects of impulsivity in alcoholics with and without a cluster-b personality disorder

Abstract: Aims: Studies have shown that alcoholics with a cluster-B personality disorder (cluster-B PD) are characterized by high levels of impulsivity. However, impulsivity has mainly been studied as a broad concept without its different aspects being considered. The present study compared abstinent alcoholic inpatients without any personality disorder (PD) and abstinent alcoholics with cluster-B PD on different aspects of impulsivity, i.e. self-reported impulsivity and neuropsychological indicators such as behavioural control and delay of gratification. Methods: Forty alcohol-dependent inpatients without PD and 22 alcohol-dependent inpatients with a cluster-B PD were compared on two self-report impulsivity questionnaires (Barratt impulsiveness scale; sensation-seeking scales) and three behavioural impulsivity tasks [Go/No-Go task; delay discounting task (DDT); Stroop colour word test]. Tests were administered after stable abstinence of at least 3 weeks. Results: Self-report measures of impulsivity were higher in cluster-B alcoholics than in alcoholics without PD. Behavioural tasks revealed a more differentiated pattern of impairments. On the Go/No-Go task, cluster-B alcoholics were impaired in inhibitory control but not in reaction time compared with alcoholics without PD. In contrast, no significant differences on the DDT and the Stroop were observed. Conclusion: Alcohol-dependent patients with and without a cluster-B PD differ in terms of behavioural inhibition but not in terms of activation or the ability to delay gratification. This finding may partly account for their impulsive and (self-) destructive behaviours. Treatment planning should pay specific attention to these impairments in behavioural control. ( Received 2 September 2005; first review notified 14 October 2005; in revised form 23 February 2006; accepted 13 March 2006)

Concurrent use of alcohol and cocaine: differences in patterns of use and problems among users of crack cocaine and cocaine powder.

Abstract: Aim: To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine. Methods: The sample of concurrent users of alcohol and cocaine (n = 102) was recruited from clinical and community (non-clinical) settings in London. Those recruited in the community were contacted by means of snowball sampling methods. Data were collected by means of face-to-face structured interviews. Results: Heavy drinking was common. There were differences in alcohol consumption between users of cocaine powder and crack cocaine. Cocaine powder users reported more frequent heavy drinking than crack users. Heavy drinking often involved drinking excessive amounts over prolonged periods. Crack cocaine users reported more serious problems associated with cocaine, other illicit drugs, psychological and physical health problems, and acquisitive crime. Conclusions: Frequent heavy drinking represents a serious risk to the health of many cocaine users. The differences in alcohol consumption patterns confirm the importance of distinguishing between use of cocaine powder and crack cocaine. Few of the sample had received treatment for cocaine or alcohol problems. Healthcare professionals working in primary care or accident and emergency settings may need to be trained to detect, assess, and respond to concurrent alcohol and cocaine problems. ( Received 25 September 2004; first review notified 22 February 2005; in revised form 19 October 2005; accepted 13 December 2005)

Gender and cultural differences in the association between family roles, social stratification, and alcohol use: a European cross-cultural analysis.

Abstract: Aims: First, this paper investigates (i) gender differences in associations of social stratification, family roles, and heavy drinking, and (ii) country differences in these associations. Second, it seeks to explain country differences in the associations of social stratification and family roles with alcohol consumption by societal level variables. Methods: Survey data of 25 to 49-years-old from eight European countries were used. Logistic regressions were used to analyse gender differences in the association between family roles (marriage, having children), social stratification (education, employment), and heavy drinking (>20 g/day for women; 30 g/day for men). Gender differences were tested by means of interactions between gender and social stratification/family roles. Structural measures of work desirability, social welfare, and gender equity were used to explain differences in associations across countries. Results: The associations between social stratification, family roles, and heavy drinking varied across gender and countries. A country's social welfare system was associated with heavy drinking only among women. Women in countries with a strong social welfare system, such as Nordic countries, tended to drink more heavily if employed, having lower formal education, and a non-traditional family role. In countries with weak social welfare systems or work desirability, heavy drinking was associated with high education, while effects of family roles and employment were small. Conclusions: It appeared that the social welfare system and gender equity of a country determines to a large extent how education, employment, and family roles are associated with heavy drinking.

'I drink spirits to get drunk and block out my problems’ Beverage preference, drinking motives and alcohol use in adolescence

Abstract: Aims: To investigate among adolescents whether (i) drinking motives are related to beverage preference; (ii) beverage preference is related to alcohol use (drinking levels and risky drinking occasions); (iii) the association between beverage preference and alcohol use is moderated or mediated by drinking motives. Method: Data from a national representative sample of 5379 8th- 10th graders in Switzerland (mean age 15.1, SD = 0.95) were analysed using multiple regression analyses. Beverage preference was based on the proportion of a specific beverage in the total amount of drinks consumed at the last drinking occasion. Drinking motives were assessed by the drinking motive questionnaire revised (DMQ-R). Results: A significant positive association was found between enhancement motives and a preference for beer and spirits; the association was negative with regard to a preference for wine and alcopops. Conformity motives were positively related to a wine preference but negatively to a beer preference. Only a preference for beer and spirits was significantly associated with alcohol use in models that exclude motives. However, the association between beer preference and adolescent alcohol use was mediated by drinking motives. A preference for alcopops and spirits was moderated by motives: social drinkers who preferred alcopops drank less than those who did not prefer alcopops. Coping drinkers who preferred spirits drank more than those who preferred other alcoholic drinks. Conclusions: Drinking motives are potential explanatory factors for the association between beverage preference and alcohol use. Prevention approaches should target coping motives, particularly for adolescents who show a preference for spirits. It is well documented in the literature that a preference for particular alcoholic beverages is associated with different drinking patterns. Drinkers of beer and spirits, for example,

Combined acamprosate and naltrexone, with cognitive behavioural therapy is superior to either medication alone for alcohol abstinence: a single centres' experience with pharmacotherapy

Abstract: Aims: To compare treatment outcomes amongst patients offered pharmacotherapy with either naltrexone or acamprosate used singly or in combination, in a 12-week outpatient cognitive behavioural therapy (CBT) programme for alcohol dependence. Methods: We matched 236 patients across gender, age group, prior alcohol detoxification, and dependence severity and conducted a cohort comparison study of three medication groups (CBT+acamprosate, CBT+naltrexone, CBT+combined medication) which included 59 patients per group. Outcome measures included programme attendance, programme abstinence and for those who relapsed, cumulative abstinence duration (CAD) and days to first breach (DFB). Secondary analyses compared the remaining matched 59 subjects who declined medication with the pharmacotherapy groups. Results: Across medication groups, CBT+ combined medication produced the greatest improvement across all outcome measures. Although a trend favoured the CBT+ combined group, differences did not reach statistical significance. Programme attendance: CBT + Acamprosate group (66.1%), CBT + Naltrexone group (79.7%), and in the CBT + Combined group (83.1%). Abstinence rates were 50.8, 66.1, and 67.8%, respectively. For those that did not complete the programme abstinent, the average number of days abstinent (CAD) were 45.07, 49.95, and 53.58 days, respectively. The average numbers of days to first breach (DFB) was 26.79, 26.7, and 37.32 days. When the focal group (CBT + combined) was compared with patients who declined medication (CBT-alone), significant differences were observed across all outcome indices. Withdrawal due to adverse medication effects was minimal. Conclusions: The addition of both medications (naltrexone and acamprosate) resulted in measurable benefit and was well tolerated. In this patient population naltrexone with CBT is as effective as combined medication with CBT, but the trend favours combination medication.

Role of the subunit composition of central nicotinic acetylcholine receptors for the stimulatory and dopamine-enhancing effects of ethanol.

Abstract: Aims: The stimulatory, rewarding, and dopamine (DA)-enhancing effects of ethanol may involve central nicotinic acetyl- choline receptors (nAChR), especially those located in the ventral tegmental area (VTA). Identifying the subunit composition that medi- ates these effects of ethanol would increase the understanding of the neurochemical basis underlying the addictive properties of ethanol. In the present series of experiments, the role of the a3b * and/or b * and/or a * subunits of the nAChR for the stimulatory and DA-enhancing effects of ethanol was investigated by using a-conotoxin MII (aCtxMII), selective to the a3b * and/or b * and/or the a * subunits of the nAChR, and the a-conotoxin PIA-analogue (aCtxPIA-analogue), suggested to be selective to the a * subunits. Methods: aCtxMII and the aCtxPIA-analogue were synthesized using a modified literature procedure. The purity and identity of the peptides were confirmed with HPLC and FAB-MS analyses, respectively. Locomotor activity and in vivo microdialysis in freely moving mice were used. Results: aCtxMII and the aCtxPIA-analogue were synthesized in good yields (>95%; >90%). In addition, we found that synthesized aCtxMII antagonized ethanol-induced locomotor stimulation, which confirms our previous results with the commercially available aCtxMII. Furthermore, the synthesized aCtxPIA-analogue, assumably also selective for a * subunits of the nAChR, did neither antagonize the stimulatory nor the accumbal DA-enhancing effects of ethanol. Conclusion: These results indicate that aCtxMII- ut not aCtxPIA-analogue-sensitive receptors, i.e. the a3b * and/or b * rather than the a * subunits of the nAChR, appear to be of greater importance for these effects of ethanol and that these subunits could constitute neurochemical targets for developing new drugs for the treatment of alcohol dependence.

Is there a future for quantifying drinking in the diagnosis, treatment, and prevention of alcohol use disorders?

Abstract: This commentary is based on a Plenary Address at th 2006 Meetingof the International Society for Biomedical Research on Alcoholism (ISBRA) held in Sydney, Australia, which posed the simple question: Is There a Future for Quantifying Drinking in the Diagnosis, Treatment, and Prevention of Alcohol Use Disorders? The intention is to stimulate dialogue among the many disciplines represented in the alcohol field about where we should be going with respect to diagnostic criteria for alcohol use disorders (AUDs), now that the American Psychiatric Association (APA) and the World Health Organization (WHO) have launched initiatives for the construction of the fifth revision of the APA Diagnostic and Statistical Manual (DSM-V) and the l1th edition of the WHO International Classification of Diseases (ICD-11). Our position is that quantifying drinking is very relevant to the diagnosis, treatment, and prevention of AUDs. Good examples are the diagnostic criteria developed over time for other complex diseases (e.g. hypertension and diabetes), in which diagnoses are a combination of quantifiable measures (e.g. blood pressure and blood glucose level) and risk factors for disease (e.g. age, weight, lifestyle, and co-morbid conditions). For each of these disorders, diagnostic criteria have developed from simple cutpoints (e.g. diastolic and systolic blood pressure cutpoints for diagnosing hypertension in relation to heart attack and stroke), but have been continually refined as data on other dimensions of risk became available. The data to develop multidimensional, scalable diagnostic criteria for AUDs similar to those for hypertension (National Heart, Lung, and Blood Institute, 2001a), diabetes (American Diabetes Association, 2006), and high blood cholesterol (National Heart, Lung, and Blood Institute, 2001b) are not yet sufficiently refined owing to the absence of quantifiable biomarkers. However, as described below, we do have enough data to begin developing diagnostic criteria for AUDs based on symptom severity and the quantification of …