Showing papers in "Alcohol and Alcoholism in 2014"

The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews.

Abstract: Aims: The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods: An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings: Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effective- ness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in tran- sitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion: This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.

Adolescent Alcohol Use: Risks and Consequences

Abstract: Aims: The aim of the study was to summarize results of recent epidemiological research on adolescent alcohol use and its consequences, to outline the risk factors for drinking in adolescents and to consider effective treatment and preventative interventions. Methods: A literature review of relevant studies on adolescent alcohol use. Results: Alcohol use and other risk-taking behaviours such as smoking, substance use and risky sexual behaviour emerge in adolescence and tend to cluster together. Heavy alcohol consumption in late adolescence appears to persist into adulthood and is associated with alcohol problems, including dependence, premature death and diminished work capacity. Early identification of adolescent risk factors may be helpful in preventing and/or attenuating risk. Conclusion: There is a need for high-quality long-term prospective cohort studies to investigate the long-term consequences of adoles- cent drinking and further work is needed to identify the most effective intervention strategies. The term 'adolescent' is an adjective describing a young person in the process of developing from a child into an adult and dates from the late 18th century (Oxford English Dictionary). It is derived from the Latin verb 'adolescere' which means 'to grow up'. This short paper will review pat- terns of drinking in adolescence and the risk factors that are thought to predispose to the development of alcohol use and other co-morbid disorders in this age group. Alcohol is the world's third largest risk factor for disease and contributes to 4% of the global burden of disease (Rehm et al., 2009). It is estimated that ~2.5 million deaths each year are directly attributable to alcohol, with 9% of deaths in the 15- to 29-year age group being alcohol-related (WHO, 2011). When data from the World Health Organization's Global Burden of Disease study were used to calculate cause-specific disability-adjusted life years (DALYs) for young people aged 10-24 years, the main risk factors were found to be alcohol (7% of DALYs), unsafe sex (4%), iron deficiency (3%), lack of contraception (2%) and illicit drug use (2%) (Gore et al., 2011). The contribution of other risk factors to disease, such as tobacco use, low physical activity and overweight/obesity only emerged in mid-to-late adulthood. These findings suggest that public health strategies should focus on child and adolescent health, and that adolescent drinking should be given priority (Gore et al., 2011).

Exposure of Children and Adolescents to Alcohol Marketing on Social Media Websites

Abstract: Aims: In 2011, online marketing became the largest marketing channel in the UK, overtaking television for the first time. This study aimed to describe the exposure of children and young adults to alcohol marketing on social media websites in the UK. Methods: We used commercially available data on the three most used social media websites among young people in the UK, from December 2010 to May 2011. We analysed by age (6-14 years; 15-24 years) and gender the reach (proportion of internet users who used the site in each month) and impressions (number of individual pages viewed on the site in each month) for Facebook, YouTube and Twitter. We further analysed case studies of five alcohol brands to assess the marketer-generated brand content available on Facebook, YouTube and Twitter in February and March 2012. Results: Facebook was the social media site with the highest reach, with an average monthly reach of 89% of males and 91% of females aged 15-24. YouTube had a similar average monthly reach while Twitter had a considerably lower usage in the age groups studied. All five of the alcohol brands studied maintained a Facebook page, Twitter page and YouTube channel, with varying levels of user engagement. Facebook pages could not be accessed by an under-18 user, but in most cases YouTube content and Twitter content could be accessed by those of all ages. Conclusion: The rise in online mar- keting of alcohol and the high use of social media websites by young people suggests that this is an area requiring further monitoring and regulation.

Alcohol screening and brief intervention for adolescents: the how, what and where of reducing alcohol consumption and related harm among young people.

Abstract: Aim: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities. Methods: A review of existing reviews (2003–2013) and a systematic review of recent research not included in earlier reviews. Results: The CRAFFT and AUDIT tools are recommended for identification of ‘at risk’ adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm. Conclusion: Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research.

Alcohol 'pre-loading': A review of the literature

Abstract: Aim: To review the international literature concerning pre-loading (PL); this is drinking before going out to pubs and bars. Method: A literature review conducted in May 2013 using the EBSCO database entering the following search terms ‘pre-loading’, ‘front-loading’, ‘pre-partying’ and ‘pre-drinking’. Thereafter, the reference lists were checked for further relevant articles. The review consisted of 40 articles of which 11 were excluded because PL was not the primary unit of analysis or they did not fulfil a quality assurance criterion. Results: Despite being an internationally widespread development to date, most of the research on this has been from the USA and UK. The majority of US studies have been concerned with PL in a college and high school setting, while the research in the UK has mainly concentrated on the correlation/relationship between PL and what takes place when drinkers enter pubs and bars later in the evening. A consistent finding was that PL is associated with greater alcohol consumption, intoxication and alcohol-related risks. The price of alcohol and achieving intoxication were the main motivations for PL. However, other reasons included a chance to meet members of the opposite sex or own friends in surroundings that encouraged interaction rather than intoxication. Conclusion: PL should be regarded as part of a wider drinking culture and understood within the context of what individuals require from a night out or staying in when drinking. There is little evidence to suggest that PL is a risk factor for admissions to accident and emergency services.

Impact of alcohol use on inhibitory control (and vice versa) during adolescence and young adulthood: a review.

Abstract: Aims: Adolescence is usually the time when individuals first drink alcohol and this has been associated with relatively weak or immature inhibitory control. This review examines the changes on brain development and inhibitory function that take place during adolescence and youth as well as the relationship between inhibitory control and alcohol use at this early age. Methods: Narrative review of the chief studies related to (a) the development of inhibitory control during adolescence, (b) the deficits in the inhibi- tory ability in alcohol use disorders and (c) the effects of acute alcohol intake and binge drinking on inhibitory control in adolescents and young adults. Results: Inhibitory control processes are developing during adolescence and youth. Poor inhibitory functions may predispose the individual to alcohol misuse. Likewise, acute and binge alcohol drinking may impair the inhibitory control and com- promise the ability to prevent or stop behaviour related to alcohol use. Conclusion: Poor inhibitory control can be both the cause and the consequence of excessive alcohol use. Adolescence and young adulthood may be a particularly vulnerable period due to (a) the weak or immature inhibitory functioning typical of this stage may contribute to the inability of the individual to control alcohol use and (b) alcohol consumption per se may alter or interrupt the proper development of inhibitory control leading to a reduced ability to regu- late alcohol intake. Further longitudinal research is needed to evaluate the interaction between inhibitory control dysfunction and alcohol use in both situations.

Binge drinking in adolescents: A review of neurophysiological and neuroimaging research

Abstract: Aims: While the relationship between chronic exposure to alcohol and neurobiological damage is well established, deleteri- ous brain effects of binge drinking in youths have only recently been studied. Methods: Narrative review of studies of brain disturbances associated with binge drinking as assessed by neuroimaging (EEG and IRMf techniques in particular) in adolescent drinkers. Results: Some major points still deserved to be investigated; directions for future research are suggested. Conclusions: Information and preven- tion programs should emphasize that binge drinking is not just inoffensive social fun, but if carried on, may contribute to the onset of cerebral disturbances possibly leading to alcohol dependence later in life.

Neuroimmune Activation and Myelin Changes in Adolescent Rats Exposed to High-Dose Alcohol and Associated Cognitive Dysfunction: A Review with Reference to Human Adolescent Drinking

Abstract: Aims: The aim of the study was to assess whether intermittent ethanol administration to adolescent rats activates innate immune response and TLRs signalling causing myelin disruption and long-term cognitive and behavioural deficits. Methods: We used a rat model of intermittent binge-like ethanol exposure during adolescence. Results: Binge-like ethanol administration to adolescent rats increased the gene expression of TLR4 and TLR2 in the prefrontal cortex (PFC), as well as inflammatory cytokines TNFα and IL-1β. Up-regulation of TLRs and inflammatory mediators were linked with alterations in the levels of several myelin proteins in the PFC of adolescent rats. These events were associated with previously reported long-term cognitive dysfunctions. Conversely, the same ethanol treatment did not cause significant changes in either inflammatory mediators or myelin changes in the brain of adult rats. Conclusion: Activation of innate immune receptors TLRs in the PFC appears to be involved in the neuroinflammation and demyelination processes induced by ethanol exposure during adolescence. The findings support the vulnerability of the juvenile brain to the effects of ethanol and the long-term cognitive consequences of binge drinking. In addition, ethanol-induced PFC dysfunctions might underlie the propen- sity of adolescents for impulsivity and to ignore the negative consequences of their behaviour, both of which could increase the risk of substance abuse.

Baclofen for the Treatment of Alcohol Dependence and Possible Role of Comorbid Anxiety

Abstract: Aim: To conduct a double-blind, placebo-controlled randomized clinical trial of baclofen in the treatment of alcohol dependence Methods: Out of 69 participants consecutively screened, 42 alcohol-dependent patients were randomized to receive placebo, baclofen 30 mg/day or baclofen 60 mg/day for 12 weeks All subjects were offered BRENDA, a structured psychosocial therapy for alcohol dependence that seeks to improve motivation for change, enhance strategies to prevent relapse and encourage com- pliance with treatment Results: Intention-to-treat analyses revealed that alcohol consumption (heavy drinking days, drinks per drinking day) significantly reduced across all three groups during the treatment period There were no statistically significant advantages to treat- ment on time to first heavy drinking day (relapse) (P= 008), nor time to first drink (lapse) (P= 018) A post hoc analysis stratifying according to whether there had been a comorbid anxiety disorder, revealed a beneficial effect of baclofen 30 mg/day versus placebo on time to lapse and relapse (P< 005) There was also a beneficial effect for baclofen 60 mg/day relative to placebo on time to relapse in this comorbid group (P<005) Both doses of baclofen were well tolerated There were no serious adverse events Conclusions: In spite of the small sample for a 3-arm clinical trial, this study suggests a specific role of baclofen in alcohol-dependent individuals with co- morbid anxiety Replication in larger, fully-powered studies is required

Pellagra and Alcoholism: A Biochemical Perspective

Abstract: Historical and clinical aspects of pellagra and its relationship to alcoholism are reviewed from a biochemical perspective. Pellagra is caused by deficiency of niacin (nicotinic acid) and/or its tryptophan (Trp) precursor and is compounded by B vitamin deficiencies. Existence on maize or sorghum diets and loss of or failure to isolate niacin from them led to pellagra incidence in India, South Africa, Southern Europe in the 18th century and the USA following the civil war. Pellagra is also induced by drugs inhibiting the conversion of Trp to niacin and by conditions of gastrointestinal dysfunction. Skin photosensitivity in pellagra may be due to decreased synthesis of the Trp metabolite picolinic acid → zinc deficiency → decreased skin levels of the histidine metabolite urocanic acid and possibly also increased levels of the haem precursor 5-aminolaevulinic acid (5-ALA) and photo-reactive porphyrins. Depression in pellagra may be due to a serotonin deficiency caused by decreased Trp availability to the brain. Anxiety and other neurological disturbances may be caused by 5-ALA and the Trp metabolite kynurenic acid. Pellagra symptoms are resolved by niacin, but aggravated mainly by vitamin B6. Alcohol dependence can induce or aggravate pellagra by inducing malnutrition, gastrointestinal disturbances and B vitamin deficiencies, inhibiting the conversion of Trp to niacin and promoting the accumulation of 5-ALA and porphyrins. Alcoholic pellagra encephalopathy should be managed with niacin, other B vitamins and adequate protein nutrition. Future studies should explore the potential role of 5-ALA and also KA in the skin and neurological disturbances in pellagra.

Contribution of time of drinking onset and family history of alcohol problems in alcohol and drug use behaviors in Argentinean college students.

Abstract: Aims: The aim of the study was to analyze independent and potential interactive effects of age at drinking onset and family history of alcohol abuse on subsequent patterns of alcohol drinking, alcohol-related problems and substance use. Methods: Participants were college students (60.3% females, mean age = 20.27 ± 2.54 years) from the city of Cordoba, Argentina. Several measures were used to assess alcohol, tobacco and drug use. The Spanish version of the Brief Young Adult Alcohol Consequences Questionnaire was used to assess alcohol-related problems. Factorial analyses of variance, or its non-parametric equivalent, were performed to explore differences in substance use behaviors and alcohol-related problems in subjects with early or late drinking onset and with or without family history of alcohol abuse. Chi-square tests were conducted to analyze the association between these two risk factors and categorical measures of alcohol, tobacco and drug use. Results: Early onset of drinking was associated with amount of consumption of alcohol including up to hazardous levels, as well as tobacco and drug use. However, the frequency of alcohol problems and frequency of episodes of alcohol intoxication were only related to age of onset in those with a positive family history of alcohol problems. Conclusion: Delaying drinking debut is particularly important in the prevention of future alcohol problems in those adolescents who have a family history of such problems.

Declining trends in alcohol consumption among Swedish youth-does the theory of collectivity of drinking cultures apply?

Abstract: AIMS: To analyse trends in alcohol consumption among young people in Sweden between 2004 and 2012, to test whether the theory of collectivity of drinking cultures is valid for a population of young people and to investigate the impact of an increasing proportion of abstainers on the overall per capita trends. METHODS: Data were drawn from an annual survey of a nationally representative sample of students in year 11 (17-18 years old). The data covered 9 years and the total sample comprised 36,141 students. Changes in the overall per capita consumption were tested using linear regression on log-transformed data, and changes in abstention rates were tested using logistic regression. The analyses were then continued by calculating average consumption in deciles. RESULTS: Alcohol consumption among year 11 students declined significantly among both boys and girls between 2004 and 2012. These changes were reflected at all levels of consumption, and the same results were found when abstainers were excluded from the analyses. The increasing proportion of abstainers had a minimal effect on the overall decline in consumption; rather, this was driven by a decline in consumption among the heaviest drinkers. CONCLUSION: The theory of collectivity of drinking cultures seems valid for understanding changes in alcohol consumption among Swedish year 11 students. No support was found for a polarization of alcohol consumption in this nationally representative sample. Language: en

Theory of mind deficit in subjects with alcohol use disorder: an analysis of mindreading processes.

Abstract: Aim: The aim of the study was to investigate multidimensional Theory of Mind (ToM) abilities in subjects with alcohol use disorder (AUD). Method : A semi-structured interview and a set of brief stories were used to investigate different components of the participants' ToM, namely first- vs. third-person, egocentric vs. allocentric, first- vs. second-order ToM in 22 persons with AUD plus an equal number of healthy controls. Participants were administered the Theory of Mind Assessment Scale (Th.o.m.a.s., [Bosco et al ., 2009a][1]) and the Strange Stories test ( [Happe et al ., 1999][2]). Results: Persons with AUD performed worse than controls at all ToM dimensions. The patterns of differences between groups varied according to the Th.o.m.a.s. dimension investigated. In particular persons with AUD performed worse at third-person than at first-person ToM, and at the allocentric than at the egocentric perspective. Conclusion : These findings support the hypothesis that the ability to understand and ascribe mental states is impaired in AUD. Future studies should focus on the relevance of the different ToM impairments as predictors of treatment outcome in alcoholism, and on the possibility that rehabilitative interventions may be diversified according to ToM assessment. [1]: #ref-5 [2]: #ref-12

Managing Alcohol Problems in General Practice in Europe: Results from the European ODHIN Survey of General Practitioners

Abstract: Aims: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems. Methods: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year. Results: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients. Conclusion: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.

The Tangible Common Denominator of Substance Use Disorders: A Reply to Commentaries to Rehm et al. (2013a)

Abstract: In response to our suggestion to define substance use disorders via ‘heavy use over time’, theoretical and conceptual issues, measurement problems and implications for stigma and clinical practice were raised. With respect to theoretical and conceptual issues, no other criterion has been shown, which would improve the definition. Moreover, heavy use over time is shown to be highly correlated with number of criteria in current DSM-5. Measurement of heavy use over time is simple and while there will be some underestimation or misrepresentation of actual levels in clinical practice, this is not different from the status quo and measurement of current criteria. As regards to stigma, research has shown that a truly dimensional concept can help reduce stigma. In conclusion, ‘heavy use over time’ as a tangible common denominator should be seriously considered as definition for substance use disorder.

Effectiveness of Nurse-Practitioner-Delivered Brief Motivational Intervention for Young Adult Alcohol and Drug Use in Primary Care in South Africa: A Randomized Clinical Trial

Abstract: Aims: To assess the effectiveness of brief motivational intervention for alcohol and drug use in young adult primary care patients in a low-income population and country. Methods: A randomized controlled trial in a public-sector clinic in Delft, a township in the Western Cape, South Africa recruited 403 patients who were randomized to either single-session, nurse practitioner-delivered Brief Motivational Intervention plus referral list or usual care plus referral list, and followed up at 3 months. Results: Although rates of at-risk alcohol use and drug use did not differ by treatment arm at follow-up, patients assigned to the Brief Motivational Intervention had significantly reduced scores on ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) for alcohol—the most prevalent substance. Conclusion: Brief Motivational Intervention may be effective at reducing at-risk alcohol use in the short term among low-income young adult primary care patients; additional research is needed to examine long-term outcomes.

Alcohol screening and brief interventions for offenders in the probation setting (SIPS Trial): a pragmatic multicentre cluster randomized controlled trial.

Abstract: Aim: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. Methods: A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service util- ization, readiness to change and reduction in conviction rates. Results: Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. Conclusion: Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.

Psychological Changes and Cognitive Impairments in Adolescent Heavy Drinkers

Abstract: Aims: Adolescence is a developmental period characterized by increased risk-taking behavior, including the initiation of alcohol and other substance use In this brief review paper we describe psychological and cognitive constructs that are associated with heavy drinking during adolescence These associations raise the question of causality: is alcohol somehow neurotoxic, or can we identify specific psychological and cognitive variables that serve as risk factors for the escalation of heavy drinking? Methods: This narrative review summarizes results of recent prospective studies that focus on causal relationships between adolescents' alcohol use, and psychological changes and cognitive impairments Results: Psychological constructs such as elevated impulsivity and poor executive function are risk factors for alcohol involvement in youth Furthermore heavy drinking during adolescence, particularly in a binge pattern, may exert neurotoxic effects and produce corresponding changes in executive function, perhaps setting the stage for the development of alcohol use disorders later on in life Conclusion: Although the findings of the discussed studies shed light on the nature of the relationships between alcohol involvement and cognitive deficits, the question of cause and effect remains unanswered The limitations of existing research and the need for well-powered prospective studies are highlighted

'Something's brewing': The changing trends in alcohol coverage in Australian newspapers 2000-2011.

Abstract: Aims: The portrayal of alcohol in the news media, including newspapers, plays an important role in influencing societalnorms and setting public agendas. We present the first large-scale examination ...

Self-intoxication with baclofen in alcohol-dependent patients with co-existing psychiatric illness: an emergency department case series.

Abstract: Aims: The aim of the study was to describe the characteristics and management of alcohol-dependent patients with co-existing psychiatric illness seen after self-intoxication with oral baclofen in an emergency department (ED). Methods: A retrospective review of medical records of such patients over a 12-month period from January 2012. Results: Twelve such patients were identified, median age 39.5 years. The median supposed ingested dose of baclofen was 340 mg (range 140–800 mg). Three patients who had co-ingested benzodiazepines had a decreased level of consciousness (Glasgow Coma Scale <8) and flumazenil had been given to reverse coma. Blood alcohol concentration, requested for all patients, was positive in three (ranging from 153 to 495 mg/100 ml). Gastric lavage was performed in two cases. All patients made a full recovery. They were discharged from the ED or intensive care unit after psychiatric assessment. Conclusion: Baclofen overdose affects the autonomic and central nervous system. Supportive care is symptom based. Care should be taken when prescribing baclofen with other central nervous system depressants and to patients with past attempted suicide.

Sports and spirits: a systematic qualitative review of emergent theories for student-athlete drinking.

Abstract: Aims: To review the current literature and critically examine theories used to explain the link between athletic status and hazardous alcohol consumption, and highlight emergent perspectives. Methods: A search of online databases (Google Scholar, PubMed, ScienceDirect, PsychINFO) and a systematic methodology were used to identify relevant studies for inclusion. Sixty-six articles were included for review (publishing dates ranging from 1989 to 2013). Results: The majority of the studies were from the USA ( n = 52), with cross-sectional surveys the most utilized method of data collection. The literature outlines a number of important sport-specific factors that may be motivating drinking behaviour among student athletes. Moreover, social processes appear particularly important for sport-associated drinking. However there is still paucity in the theoretical underpinnings for this relationship, and the processes through which membership of a sports group may shape its members drinking. The role of identity emerged as an important variable to consider when exploring engagement of health behaviours, such as alcohol consumption. Conclusions: With the aim of reducing alcohol-related harm, the impact of sports group membership on psychosocial variables such as social identity and well-being warrants further exploration. Future research should explore the role of identity and group-level processes when examining the engagement of drinking behaviours of student sportspeople.

A comparative study of fixed tapering dose regimen versus symptom-triggered regimen of lorazepam for alcohol detoxification.

Abstract: Aims: The study aimed at comparing the fixed tapering dose and the symptom-triggered regimens of lorazepam for alcohol detoxification. Methods: We carried out a prospective, randomized, double blind controlled trial involving 63 consecutive consenting male patients admitted with diagnosis of uncomplicated alcohol withdrawal. The patients were randomized into two groups based on the type of lorazepam dosage: symptom-triggered ( n = 33) and fixed tapering dose regimens ( n = 30). Alcohol withdrawal symptoms were rated on CIWA-Ar (Clinical Institute Withdrawal Assessment – Alcohol revised). The main outcome measures were the total amount and duration of lorazepam treatment and the incidence of adverse events or complications. Results: The mean lorazepam dose administered in the symptom-triggered group was significantly lower than in the fixed tapering dose group (9.5 versus 19.9 mg, P < 0.001) and for a significantly shorter duration of time (47.8 versus 146 h, P < 0.001) with more significant results for higher initial CIWA-Ar scores. There were no significant differences between both the groups in terms of the incidence of complications like seizures or delirium tremens. Conclusion: Symptom-triggered lorazepam treatment for alcohol withdrawal resulted in administration of lower total doses of medication for a shorter duration of treatment and was as safe as the fixed tapering dose.

Utilization of Baclofen in Maintenance of Alcohol Abstinence in Patients with Alcohol Dependence and Alcoholic Hepatitis with or without Cirrhosis

Abstract: Aim: To report the efficacy and safety of baclofen in improving clinical state in patients with alcoholic hepatitis. Method: Single center, open, retrospective study analyzing the effects of baclofen utilized over 12 months in patients with alcoholic hepatitis with or without cirrhosis and alcohol dependence on these liver parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (Tbili), prothrombin time (PT), international normalized ratio (INR), albumin and Model for End-Stage Liver Disease (MELD) score. Results: Out of 40 patients, 35 were treated with baclofen. On average, baclofen was used for 5.8 months. A significant decrease in the mean AST, ALT, Tbili, INR, PT and MELD score was seen when comparing pre-baclofen use compared with post-baclofen use. Of the 35 patients who were started on baclofen, 34 (97%) remained abstinent. There were no serious adverse events. Conclusions: Baclofen's safety and efficacy in improving the clinical condition patients with alcoholic liver disease has been supported. Randomized prospective studies with longer duration of baclofen in this population may further optimize its use and corroborate efficacy.

Alcohol consumption and risky drinking patterns in Malaysia: findings from NHMS 2011

Abstract: AIMS:: To identify the characteristics of current drinker and risky alcohol-drinking pattern by profiles in Malaysia. METHODS:: We analyzed data from the National Health and Morbidity Survey 2011. It was a cross-sectional population-based with two stages stratified random sampling design. A validated Alcohol Use Disorder Identification Test Malay questionnaire was used to assess the alcohol consumption and its alcohol related harms. Analysis of complex survey data using Stata Version 12 was done for descriptive analysis on alcohol use and risky drinking by socio-demography profiles. Logistic regression analysis was used to measure the association of risky drinking status with the socio-demography characteristics. RESULTS:: The prevalence of current alcohol use was 11.6% [95% confidence interval (CI): 10.5, 12.7], among them 23.6% (95% CI: 21.0, 26.4) practiced risky drinking. The onset for alcohol drinking was 21 years old (standard deviation 7.44) and majority preferred Beer. Males significantly consumed more alcohol and practiced risky drinking. Current alcohol use was more prevalent among urbanites, Chinese, those with high household income, and high education. Conversely, risky drinking was more prevalent among rural drinkers, Bumiputera Sabah and Sarawak, low education and low household income. The estimated odds of risky drinking increased by a factor of 3.5 among Males while a factor of 2.7 among Bumiputera Sabah and Sarawak. Education status and household income was not a significant predictor to risky drinking. CONCLUSION:: There was an inverse drinking pattern between current drinker and risky drinking by the socio-demography profiles. Initiating early screening and focused intervention might avert further alcohol related harms and dependence among the risky drinkers. Language: en

Sy17-4prevalence of pathological gambling in japan: results of national surveys of the general adult population in 2008 and 2013

Abstract: Introduction. A meta-analysis of 119 studies performed in North America found that the lifetime prevalences of pathological gambling in adults are 1.6 percent. We conducted national surveys on addictive behavior to estimate the prevalence of pathological gambling.Methods. A survey of 7,500 men and w

Quality of Life Depends on the Drinking Pattern in Alcohol-Dependent Patients

Abstract: Aims: In patients with alcohol dependence, health-related quality of life (QOL) is reduced compared with that of a normal healthy population. The objective of the current analysis was to describe the evolution of health-related QOL in adults with alcohol dependence during a 24-month period after initial assessment for alcohol-related treatment in a routine practice setting, and its relation to drinking pattern which was evaluated across clusters based on the predominant pattern of alcohol use, set against the influence of baseline variables Methods: The Medical Outcomes Study 36-Item Short-Form Survey (MOS-SF-36) was used to measure QOL at baseline and quarterly for 2 years among participants in CONTROL, a prospective observational study of patients initiating treatment for alcohol dependence. The sample consisted of 160 adults with alcohol dependence (65.6% males) with a mean (SD) age of 45.6 (12.0) years. Alcohol use data were collected using TimeLine Follow-Back. Based on the participant's reported alcohol use, three clusters were identified: 52 (32.5%) mostly abstainers, 64 (40.0%) mostly moderate drinkers and 44 (27.5%) mostly heavy drinkers. Mixed-effect linear regression analysis was used to identify factors that were potentially associated with the mental and physical summary MOS-SF-36 scores at each time point. Results: The mean (SD) MOS-SF-36 mental component summary score (range 0–100, norm 50) was 35.7 (13.6) at baseline [mostly abstainers: 40.4 (14.6); mostly moderate drinkers 35.6 (12.4); mostly heavy drinkers 30.1 (12.1)]. The score improved to 43.1 (13.4) at 3 months [mostly abstainers: 47.4 (12.3); mostly moderate drinkers 44.2 (12.7); mostly heavy drinkers 35.1 (12.9)], to 47.3 (11.4) at 12 months [mostly abstainers: 51.7 (9.7); mostly moderate drinkers 44.8 (11.9); mostly heavy drinkers 44.1 (11.3)], and to 46.6 (11.1) at 24 months [mostly abstainers: 49.2 (11.6); mostly moderate drinkers 45.7 (11.9); mostly heavy drinkers 43.7 (8.8)]. Mixed-effect linear regression multivariate analyses indicated that there was a significant association between a lower 2-year follow-up MOS-SF-36 mental score and being a mostly heavy drinker (−6.97, P < 0.001) or mostly moderate drinker (−3.34 points, P = 0.018) [compared to mostly abstainers], being female (−3.73, P = 0.004), and having a Beck Inventory scale score ≥8 (−6.54, P < 0.001), at baseline. The mean (SD) MOS-SF-36 physical component summary score was 48.8 (10.6) at baseline, remained stable over the follow-up and did not differ across the three clusters. Mixed-effect linear regression univariate analyses found that the average 2-year follow-up MOS-SF-36 physical score was increased (compared with mostly abstainers) in mostly heavy drinkers (+4.44, P = 0.007); no other variables tested influenced the MOS-SF-36 physical score. Conclusion: Among individuals with alcohol dependence, a rapid improvement was seen in the mental dimension of QOL following treatment initiation, which was maintained during 24 months. Improvement was associated with the pattern of alcohol use, becoming close to the general population norm in patients classified as mostly abstainers, improving substantially in mostly moderate drinkers and improving only slightly in mostly heavy drinkers. The physical dimension of QOL was generally in the normal range but was not associated with drinking patterns.

Do individual and situational factors explain the link between predrinking and heavier alcohol consumption? An event-level study of types of beverage consumed and social context

Abstract: Aim: Predrinking (drinking in private settings before going to licensed premises) has been shown to be positively asso- ciated with amount of alcohol consumed. The present study assesses whether this association is explained by general drinking patterns or situational factors, including drinking duration, beverage type and drinking companions. Methods: In a sample of 183 young adults from French-speaking Switzerland, data on alcohol consumption, whereabouts and drinking companions were collected using question- naires sent to participants' cell phones at five time points from 5 p.m. to midnight every Thursday, Friday and Saturday over five con- secutive weeks. Means and proportion tests and multilevel models were conducted based on 6650 assessments recorded on 1441 evenings. Results: Over the study period, predrinkers drank more frequently than did non-predrinkers and, among males, predrinkers drank more heavily. Predrinking was related to increased drinking duration and thus total consumption in the evenings. Larger groups of people were reported for predrinking compared with off-premise only drinking situations. Among women, the consumption of straight spirits (i.e. not mixed with soft drinks) while predrinking was associated with higher total evening alcohol consumption. Among men, drinking with exclusively male friends or female friends while predrinking was associated with higher consumption. Conclusion: Heavier drinking on predrinking evenings mainly results from longer drinking duration, with individual and situational factors playing a smaller role. Prevention efforts on reducing the time that young adults spend drinking and harm reduction measures such as restriction of access to on-premise establishments once intoxicated are recommended.

Interactive effects of OPRM1 and DAT1 genetic variation on subjective responses to alcohol.

Abstract: Aims: Subjective response to alcohol represents a marker of alcoholism risk. The A118G single-nucleotide polymorphism (SNP) of the mu opioid receptor (OPRM1) gene has been associated with subjective response to alcohol. Recently, the dopamine trans- porter (DAT1) variable number of tandem repeat (VNTR; SLC6A3) has been found to interact with the OPRM1 A118G SNP in predict- ing neural and behavioral responses to naltrexone and to alcohol. This exploratory study examines the OPRM1× DAT1 interaction on subjective responses to alcohol. Methods: Non-treatment-seeking problem drinkers (n= 295) were assessed in the laboratory for alcohol dependence. Following prospective genotyping for the OPRM1 gene, 43 alcohol-dependent individuals were randomized to two intravenous infusion sessions, one of alcohol (target BrAC = 0.06 g/dl) and one of saline. Measures of subjective responses to alcohol were administered in both infusion sessions. Results: Analyses revealed significant Alcohol × OPRM1× DAT1 interactions for alcohol-induced stimulation, vigor and positive mood as well as significant Alcohol × OPRM1 × DAT1 × Time interactions for stimula- tion and positive mood. These effects were such that, compared with other genotype groups, OPRM1 G-allele carriers + DAT1 A10 homozygotes reported steeper increases in stimulation and positive mood across rising BrAC, when compared with placebo. All Alcohol ×OPRM1 × DAT1 interactions remained significant when analyses were restricted to a subsample of Caucasian participants (n= 34); however, 4-way interactions did not reach statistical significance in this subsample. Conclusions: This study suggests that the contribution of OPRM1 genotype to alcohol-induced stimulation, vigor and positive mood is moderated by DAT1 genotype. These find- ings are consistent with the purported interaction between opioidergic and dopaminergic systems in determining the reinforcing proper- ties of alcohol.

Comparison of Phosphatidylethanol Results to Self-Reported Alcohol Consumption Among Young Injection Drug Users

Abstract: Aims: To test the value of phosphatidylethanol (PEth) as a biomarker for alcohol consumption among injecting drug users (IDUs). Methods: As part of a longitudinal study of young IDUs, dried blood spots and self-reported alcohol by structured interview were collected at baseline. We compared self-reported alcohol use to detectable PEth (≥8 ng/ml) in the blood spots as well as the rela- tionships between quantitative PEth results and quantity measures of alcohol consumption. Results: There were strong associations between PEth and self-reported categorical measures of alcohol consumption (all P< 0.01). There was high specificity for reporting abstaining from alcohol; 94% of those who reported not consuming alcohol in the prior month tested negative for PEth. PEth was well correlated with measures of alcohol use (e.g. with reported number of days drinking in the prior month: Spearman r =0.70 (P< 0.001)). Conclusions: The positive correlation of PEth with reported alcohol consumption suggests that PEth may be a useful marker in settings where alcohol consumption is difficult to assess, or to corroborate or invalidate self-reported measures of alcohol con- sumption.

The Postmortem Diagnosis of Alcoholic Ketoacidosis

Abstract: Aims: The aim of this article is to review the forensic literature covering the postmortem investigations that are associated with alcoholic ketoacidosis fatalities and report the results of our own analyses. Methods: Eight cases of suspected alcoholic ketoacidosis that had undergone medico-legal investigations in our facility from 2011 to 2013 were retrospectively selected. A series of laboratory parameters were measured in whole femoral blood, postmortem serum from femoral blood, urine and vitreous humor in order to obtain a more general overview on the biochemical and metabolic changes that occur during alcoholic ketoacidosis. Most of the tested parameters were chosen among those that had been described in clinical and forensic literature associated with alcoholic ketoacidosis and its complications. Results: Ketone bodies and carbohydrate-deficient transferrin levels were increased in all cases. Biochemical markers of generalized inflammation, volume depletion and undernourishment showed higher levels. Adaptive endocrine reactions involving insulin, glucagon, cortisol and triiodothyronine were also observed. Conclusions: Metabolic and biochemical disturbances characterizing alcoholic ketoacidosis can be reliably identified in the postmortem setting. The correlation of medical history, autopsy findings and biochemical results proves therefore decisive in identifying pre-existing disorders, excluding alternative causes of death and diagnosing alcoholic ketoacidosis as the cause of death.