Showing papers in "Alcohol and Alcoholism in 2016"
TL;DR: A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.
Abstract: Aims To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care.
Methods Analyses of guidelines and recommendations, reviews and meta-analyses.
Results Many recommendations or guidelines for interventions for people with alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: s creening for alcohol use and alcohol-related problems, b rief i nterventions for hazardous and in some cases harmful drinking, r eferral to specialized t reatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders).
Conclusions A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.
121 citations
TL;DR: The most promising results associated with AUD and alcohol-related phenotypes have included SNPs of the alcohol metabolism genes ADH and ALDH, which have been found to be protective against the development of AUD.
Abstract: Aims Alcohol Use Disorder (AUD) is a chronic psychiatric illness characterized by harmful drinking patterns leading to negative emotional, physical, and social ramifications. While the underlying pathophysiology of AUD is poorly understood, there is substantial evidence for a genetic component; however, identification of universal genetic risk variants for AUD has been difficult. Recent efforts in the search for AUD susceptibility genes will be reviewed in this article.
Methods In this review, we provide an overview of genetic studies on AUD, including twin studies, linkage studies, candidate gene studies, and genome-wide association studies (GWAS).
Results Several potential genetic susceptibility factors for AUD have been identified, but the genes of alcohol metabolism, alcohol dehydrogenase ( ADH ) and aldehyde dehydrogenase ( ALDH ), have been found to be protective against the development of AUD. GWAS have also identified a heterogeneous list of SNPs associated with AUD and alcohol-related phenotypes, emphasizing the complexity and heterogeneity of the disorder. In addition, many of these findings have small effect sizes when compared to alcohol metabolism genes, and biological relevance is often unknown.
Conclusions Although studies spanning multiple approaches have suggested a genetic basis for AUD, identification of the genetic risk variants has been challenging. Some promising results are emerging from GWAS studies; however, larger sample sizes are needed to improve GWAS results and resolution. As the field of genetics is rapidly developing, whole genome sequencing could soon become the new standard of interrogation of the genes and neurobiological pathways which contribute to the complex phenotype of AUD.
Short summary This review examines the genetic underpinnings of Alcohol Use Disorder (AUD), with an emphasis on GWAS approaches for identifying genetic risk variants. The most promising results associated with AUD and alcohol-related phenotypes have included SNPs of the alcohol metabolism genes ADH and ALDH .
108 citations
TL;DR: FASD is a significant public health and social problem that consumes resources, both economic and societal, in Canada and many of the costs could be reduced with the implementation of effective social policies and intervention programs.
Abstract: Aim To estimate the economic burden and cost attributable to Fetal Alcohol Spectrum Disorder (FASD) in Canada in 2013.
Methods This cost-of-illness study examined the impact of FASD on the material welfare of the Canadian society in 2013 by analyzing the direct costs of resources expended on health care, law enforcement, children and youth in care, special education, supportive housing, long-term care, prevention and research, as well as the indirect costs of productivity losses of individuals with FASD due to their increased morbidity and premature mortality.
Results The costs totaled approximately $1.8 billion (from about $1.3 billion as the lower estimate up to $2.3 billion as the upper estimate). The highest contributor to the overall FASD-attributable cost was the cost of productivity losses due to morbidity and premature mortality, which accounted for 41% ($532 million–$1.2 billion) of the overall cost. The second highest contributor to the total cost was the cost of corrections, accounting for 29% ($378.3 million). The third highest contributor was the cost of health care at 10% ($128.5–$226.3 million).
Conclusions FASD is a significant public health and social problem that consumes resources, both economic and societal, in Canada. Many of the costs could be reduced with the implementation of effective social policies and intervention programs.
95 citations
TL;DR: The alcohol industry is in violation of their proposed self-regulation guidelines for digital marketing communications on Instagram while Twitter's age-gate effectively blocked direct to phone updates, unhindered access to post was possible.
Abstract: Aims Assess whether alcohol companies restrict youth/adolescent access, interaction, and exposure to their marketing on Twitter and Instagram.
Methods Employed five fictitious male and female Twitter ( n = 10) and Instagram ( n = 10) user profiles aged 13, 15, 17, 19 and/or 21. Using cellular smartphones, we determined whether profiles could (a) interact with advertising content—e.g. retweet, view video or picture content, comment, share URL; and/or (b) follow and directly receive advertising material updates from the official Instagram and Twitter pages of 22 alcohol brands for 30 days.
Results All user profiles could fully access, view, and interact with alcohol industry content posted on Instagram and Twitter. Twitter's age-gate, which restricts access for those under 21, successfully prevented underage profiles from following and subsequently receiving promotional material/updates. The two 21+ profiles collectively received 1836 alcohol-related tweets within 30 days. All Instagram profiles, however, were able to follow all alcohol brand pages and received an average of 362 advertisements within 30 days. The quantity of promotional updates increased throughout the week, reaching their peak on Thursday and Friday. Representatives/controllers of alcohol brand Instagram pages would respond directly to our underage user's comments.
Conclusion The alcohol industry is in violation of their proposed self-regulation guidelines for digital marketing communications on Instagram. While Twitter's age-gate effectively blocked direct to phone updates, unhindered access to post was possible. Everyday our fictitious profiles, even those as young as 13, were bombarded with alcohol industry messages and promotional material directly to their smartphones.
83 citations
TL;DR: D dose-dependent associations between long-term alcohol intake and breast, UADT and colorectal cancer are confirmed and are confirmed in a systematic review and meta-analysis.
Abstract: Aims Cancers of female breast, upper aero-digestive tract (UADT) (oral cavity, pharynx, larynx, oesophagus) and colorectum are causally related to alcohol consumption. Although alcohol consumption is likely to vary during life, the few studies that have explicitly measured lifetime consumption or intake over time have not been summarised. We therefore conducted a systematic review and meta-analysis.
Methods Studies were identified by searching the Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Scopus databases through January 2015 using broad search criteria. Studies reporting relative risks (RR) for quantitatively defined categories of alcohol consumption over time for breast, UADT or colorectal cancer were eligible. A two-stage random-effects meta-analysis was used to estimate a dose–response relationship between alcohol intake and each cancer site. RRs were also calculated for the highest relative to the lowest intake category.
Results Sixteen articles for breast, 16 for UADT and 7 for colorectal cancer met the eligibility criteria. We observed a weak non-linear dose–response relationship for breast cancer and positive linear dose–response relationships for UADT and colorectal cancer. The pooled RRs were 1.28 (95% confidence interval, CI: 1.07, 1.52) for breast, 2.83 (95% CI: 1.73, 4.62) for UADT, 4.84 (95% CI: 2.51, 9.32) for oral cavity and pharynx, 2.25 (95% CI: 1.49, 3.42) for larynx, 6.71 (95% CI: 4.21, 10.70) for oesophageal and 1.49 (95% CI: 1.27, 1.74) for colorectal cancer.
Conclusion Our findings confirm dose-dependent associations between long-term alcohol intake and breast, UADT and colorectal cancer.
81 citations
TL;DR: The alcoholic group reported less sensitivity to sweet taste suggests that drinking habits may influence choice of foods, with a greater preference for foods with higher sucrose concentration, which contribute to poor health.
Abstract: Aims To determine the threshold index of sweet and salty tastes in alcoholics undergoing treatment.
Methods Taste threshold was assessed using type 3-Alternative Forced Choice in a control group (92 non-alcoholic volunteers) and a test group (92 alcoholics in therapy). The test group completed a structured questionnaire on lifestyle and habits.
Results Significant difference were found between the threshold rates found in the test (3.78) and control groups (1.39). In the salty stimulus, no significant difference was noted in the threshold detection between the control (0.17) and test groups (0.30). A significant correlation was observed between the index Pearson's threshold to sweet taste in the test group and their reported alcohol consumption. The test group reported characteristics such as loss of appetite (93%), weight loss during consumption (62%) and weight gain after quitting drinking (72%).
Conclusion That the alcoholic group reported less sensitivity to sweet taste suggests that drinking habits may influence choice of foods, with a greater preference for foods with higher sucrose concentration. This contribute to poor health, because excess consumption of sugar raises risk for several diseases. No conclusive results were found for the salty stimulus.
73 citations
TL;DR: Alcohol use, misuse and dependence cause cognitive impairment and alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation.
Abstract: Aims To investigate the underlying neurobiology between alcohol use, misuse and dependence and cognitive impairment, particularly Alzheimer's disease (AD).
Methods Review of the literature using searches of Medline, Pubmed, EMBASE, PsycInfo, and meeting abstracts and presentations.
Results The role of alcohol as a risk factor and contributor for cognitive decline associated with AD has received little attention. This is despite the high prevalence of alcohol use, the potential reversibility of a degree of cognitive impairment and the global burden of AD. Until now the focus has largely been on the toxic effects of alcohol, neuronal loss and the role of thiamine.
Conclusion We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation. We describe the common underlying neurobiology in alcohol and AD, and examine ways alcohol likely contributes to neuroinflammation directly via stimulation of Toll-like receptors and indirectly from small bowel changes, hepatic changes, withdrawal and traumatic brain injury to the pathogenesis of AD.
Short Summary Alcohol use, misuse and dependence cause cognitive impairment. We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation.
70 citations
TL;DR: The survey observed many hidden alcoholic patients, and showed the possibility that the healthcare facilities and health screening became the place of screening and intervention for alcohol dependence.
Abstract: Aims Nationwide surveys to clarify the characteristics and trends of the drinking behavior of Japanese adults were carried out in 2003, 2008, and 2013.
Methods These were periodical cross-sectional surveys. Subjects were chosen through a stratified two-stage random sampling method. The surveys included drinking frequency and amount, ICD-10 alcoholism diagnostic standards, questionnaire for the determination of harmful alcohol use (AUDIT: Alcohol Use Disorders Identification Test). In 2003, the surveys obtained responses from 2547 people (73% response rate); in 2008, 4123 people (55% response rate); and in 2013, 4153 people (59% response rate).
Results The proportion of lifetime experience of alcohol dependence diagnosed by ICD-10 was 1.9% for male and 0.2% for female, and the estimated number of patients was 1.07 million. The declining trends were observed in the percentage of daily drinkers and the amount of alcohol consumed per week for male. The lowering of the age for consuming their first alcoholic drink and their first drunken experience was observed among female. The gender difference of prevalence of problem drinking is getting smaller. The binge drinking and heavy episodic drinking were observed especially younger generation. The only small proportion of patients with alcohol dependence had received specialized medical care, whereas the many of these visited medical institutions and health screening.
Conclusions The survey observed many hidden alcoholic patients, and showed the possibility that the healthcare facilities and health screening became the place of screening and intervention for alcohol dependence.
67 citations
TL;DR: It is demonstrated that more than 1 in 5 persons with alcohol use disorder (AUDs) has the metabolic syndrome, and routine screening and multidisciplinary management of metabolic abnormalities in people with AUD is needed.
Abstract: Aims People with alcohol use disorders (AUDs) have a double increased risk for cardiovascular diseases (CVD) and associated premature mortality. Metabolic syndrome (MetS) and its components are highly predictive of CVD. The primary aim of this meta-analysis was to describe pooled rates of MetS and its components in people with AUDs taking into account variations in demographic and clinical variables. Methods Medline, Embase and CINAHL were searched until 03/2016 for cross-sectional and baseline data of longitudinal studies in adults with AUDs. Two independent reviewers extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed. Results The pooled MetS prevalence after adjusting for publication bias was 21.8% (95% CI = 19.1%-24.8%; N studies = 5; n participants = 865; age range = 34.8-51.1 years). Abdominal obesity was observed in 38.3% (N = 4, n = 389; 95%CI = 30.2%-47.0%), hyperglycemia in 14.3% (N = 4, n = 389; 95% CI = 3.7%-42.3%), hypertriglyceridemia in 43.9% (N = 4, n = 389; 95% CI = 31.7%-56.8%), low high-density lipoprotein cholesterol in 7.6% (N = 4, n = 389; 95% CI = 4.3%-13.2%) and hypertension in 46.5% (95% CI = 21.7%-73.1%). The MetS prevalence was similar across settings. A separate meta-regression analysis revealed that a higher MetS frequency was moderated by a higher percentage of psychiatric co-morbidity (coefficient = 3.651; standard error = 1.10, 95% CI = 1.50 to 5.80, z = 3.3, P Short summary The metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. Our meta-analysis demonstrates that more than 1 in 5 persons with alcohol use disorder (AUDs) has the MetS. Routine screening and multidisciplinary management of metabolic abnormalities should be an integral part of the multidisciplinary treatment of AUDs.
64 citations
TL;DR: The results indicate that the wide range of deficits apparent in alcohol-dependent individuals are not evident in this younger, heavy drinking population, but that specific performance and self-identified deficits are already apparent.
Abstract: Aims A substantial number of university students exceed alcohol guidelines Impulsivity has been repeatedly implicated in heavy alcohol use, yet despite knowledge that impulsivity is multifaceted, there have previously been few studies applying multiple measures of self-report and behavioural impulsivity to examine the relationship with excessive student drinking This results in a limited understanding of the relationship of various facets of impulsivity to student drinking
Methods Participants completed a comprehensive battery of impulsivity measures: the Barratt Impulsiveness Scale as a self-report index and the Stop Signal Task, Information Sampling Task and Monetary Choice Questionnaire as behavioural measures of three facets of impulsivity Participants who exceeded UK drinking guidelines were compared to those who did not on measures of impulsivity Hierarchical linear regression was then employed to test whether indices of impulsivity were associated with the average units consumed per week
Results Participants who exceeded UK guidelines reported increased impulsivity in facets of self-report impulsivity They also displayed performance deficits in normal adjustment of Go responses on the Stop Signal Task In the regression model, nonplanning impulsivity on the Barratt Impulsiveness Scale was seen to predict quantity of alcohol consumed per month
Conclusions The study applies a comprehensive selection of behavioural and self-report measures of impulsivity and indicates that excessive drinkers are more impulsive in some but not all aspects The results indicate that the wide range of deficits apparent in alcohol-dependent individuals are not evident in this younger, heavy drinking population, but that specific performance and self-identified deficits are already apparent
58 citations
TL;DR: Findings corroborate the results of previous systematic reviews that reported a positive association between exposure to alcohol marketing and alcohol consumption and the relationship between alcohol sports sponsorship and increased drinking amongst schoolchildren will concern policymakers.
Abstract: Aim Concerns have been raised about the impact of alcohol sports sponsorship on harmful consumption, with some countries banning this practice or considering a ban. We review evidence on the relationship between exposure to alcohol sports sponsorship and alcohol consumption.
Methods Search of electronic databases (PubMed, Cochrane Library, Google Scholar and International Alcohol Information Database) supplemented by hand searches of references and conference proceedings to locate studies providing data on the impact of exposure to alcohol sports sponsorship and outcomes relating to alcohol consumption.
Results Seven studies met inclusion criteria, presenting data on 12,760 participants from Australia, New Zealand, the UK, Germany, Italy, Netherlands and Poland. All studies report positive associations between exposure to alcohol sports sponsorship and self-reported alcohol consumption, but the statistical significance of results varies. Two studies found indirect exposure to alcohol sports sponsorship was associated with increased levels of drinking amongst schoolchildren, and five studies found a positive association between direct alcohol sports sponsorship and hazardous drinking amongst adult sportspeople.
Conclusion These findings corroborate the results of previous systematic reviews that reported a positive association between exposure to alcohol marketing and alcohol consumption. The relationship between alcohol sports sponsorship and increased drinking amongst schoolchildren will concern policymakers. Further research into the effectiveness of restrictions on alcohol sports sponsorship in reducing harmful drinking is required.
TL;DR: Results of this study suggest that AUD may be associated with impaired understanding of others' intentions and emotions, which can leave an individual vulnerable to misinterpreting social cues.
Abstract: Aim Research into Theory of Mind (ToM) in alcohol use disorder (AUD) is sparse and the extant findings contradictory. The objective of this paper was to conduct a meta-analysis to determine whether individuals with AUD show ToM deficits across the available published literature.
Method A comprehensive literature search was performed with the PsychInfo, PubMed and Web Science databases for studies from 1990 to March 2015, pairing the keywords ‘alcohol’ and ‘theory of mind’. Results were filtered and eight studies met the inclusion criteria and were included in the final meta-analysis.
Results Results showed that individuals with AUD ( n = 187) displayed reduced ToM compared to controls ( n = 187). Hedges' g was −1.62 [(−2.28, −0.96), SE = 0.66, P < 0.01], which is indicative of a large effect size. The percentage of males had a significant impact on the effect size, Q = 7.90, P = 0.005, while IQ and level of education did not.
Conclusions Results of this study suggest that AUD may be associated with impaired understanding of others' intentions and emotions, which can leave an individual vulnerable to misinterpreting social cues. Clinical care implications of the findings, limitations of the study, and suggestions for future research are discussed.
TL;DR: The continued burden of illness observed in these already-diagnosed patients suggests an unmet need in both primary and secondary care, and high DRL was significantly associated with depression, greater work productivity losses, increased hospitalisations and rehabilitation stays.
Abstract: AIMS: Alcohol dependence is associated with high rates of co-occurring disorders which impact health-related quality of life (HRQoL) and add to the cost-of-illness. This study investigated the burden of alcohol dependence and associated co-occurring conditions on health and productivity. METHODS: A cross-sectional survey was conducted in eight European countries. Physicians (Psychiatrists and General Practitioners) completed patient record forms, which included assessment of co-occurring conditions, and patients completed matching self-completion forms. Drinking risk level (DRL) was calculated and the relationship between DRL, co-occurring conditions, work productivity, hospitalisations and rehabilitation stays was explored. RESULTS: Data were collected for 2979 alcohol-dependent patients (mean age 48.8 ± 13.6 years; 70% male). In total, 77% of patients suffered from moderate-to-severe co-occurring psychiatric and/or somatic conditions. High DRL was significantly associated with depression, greater work productivity losses, increased hospitalisations and rehabilitation stays. Co-occurring conditions were significantly associated with poorer HRQoL and decreased work productivity, with a statistical trend towards an increased frequency of rehabilitation stays. CONCLUSIONS: Alcohol-dependent patients manifest high rates of co-occurring psychiatric and somatic conditions, which are associated with impaired work productivity and HRQoL. The continued burden of illness observed in these already-diagnosed patients suggests an unmet need in both primary and secondary care. Language: en
TL;DR: Ethanol oxidation by intestinal obligate anaerobes under aerobic conditions in the colon and rectum could also play an important role in the pathogenesis of ethanol-related colorectal cancer.
Abstract: Aims The importance of ethanol oxidation by intestinal aerobes and facultative anaerobes under aerobic conditions in the pathogenesis of ethanol-related colorectal cancer has been proposed. However, the role of obligate anaerobes therein remains to be established, and it is still unclear which bacterial species, if any, are most important in the production and/or elimination of carcinogenic acetaldehyde under such conditions. This study was undertaken to address these issues.
Methods More than 500 bacterial strains were isolated from the faeces of Japanese alcoholics and phylogenetically characterized, and their aerobic ethanol metabolism was studied in vitro to examine their ability to accumulate acetaldehyde beyond the minimum mutagenic concentration (MMC, 50 µM).
Results Bacterial strains that were considered to potentially accumulate acetaldehyde beyond the MMC under aerobic conditions in the colon and rectum were identified and referred to as ‘potential acetaldehyde accumulators’ (PAAs). Ruminococcus , an obligate anaerobe, was identified as a genus that includes a large number of PAAs. Other obligate anaerobes were also found to include PAAs. The accumulation of acetaldehyde by PAAs colonizing the colorectal mucosal surface could be described, at least in part, as the response of PAAs to oxidative stress.
Conclusion Ethanol oxidation by intestinal obligate anaerobes under aerobic conditions in the colon and rectum could also play an important role in the pathogenesis of ethanol-related colorectal cancer.
TL;DR: Melatonin could protect against liver injury caused by alcohol gastric perfusion and may be related to alleviating lipid peroxidation and upregulating the activity of AMPK mediated by MT1R signaling pathway.
Abstract: Aims Melatonin is supposed to be an effective hepatoprotective agent. The effects and mechanisms of melatonin on alcoholic fatty liver (AFL) have not been well explored. The aim of this study was to investigate the preventive and therapeutic effects of melatonin on alcohol-induced fatty liver rats.
Methods The AFL rats were induced by intragastric infusion of alcohol plus a high-fat diet for 6 weeks, and melatonin (10, 20, 40 mg/kg) was administered by gastric perfusion. We also established fatty acid overload cell model in HepG2 cells to investigate the effect of melatonin on AMP-activated protein kinase (AMPK) activity.
Results The results showed that melatonin (20 and 40 mg/kg) administration significantly reduced alcohol-induced hepatic steatosis with lowering activities of serum alanine aminotransferase, aspartate aminotransferase and levels of serum and hepatic triglyceride. The activity of superoxide dismutase was increased and the content of malondialdehyde was decreased in liver homogenates of rats treated with melatonin. Melatonin increased the phosphorylation of AMPK in the liver tissues of alcohol-induced rats as well. Additionally, in vitro studies showed that melatonin increased the expression of melatonin1A receptor (MT1R), whereas luzindole, a receptor antagonist of melatonin, had no effect on its expression. In addition, melatonin reduced the levels of adenosine 3′,5′-cyclic monophosphate (cAMP) and increased the phosphorylation of AMPK, and melatonin treatment could markedly reverse these effects.
Conclusion In conclusion, melatonin could protect against liver injury caused by alcohol gastric perfusion. The effect may be related to alleviating lipid peroxidation and upregulating the activity of AMPK mediated by MT1R signaling pathway.
TL;DR: It is shown that sub-chronic pre-treatment of the GHS-R1A antagonist, JMV2959, attenuated the ability of acute administration of alcohol as well as of amphetamine to stimulate locomotion and suggests that the G HS-R 1A could be a key target for novel treatment strategies for addiction.
Abstract: Aims Ghrelin initially emerged as a gut-brain hormone controlling food intake, meal initiation and appetite mainly via hypothalamic circuits in both rodents and humans. The findings that ghrelin receptors (GHS-R1A) are expressed in reward-related areas, including the nucleus accumbens (NAc) and ventral tegmental area (VTA), suggest that ghrelin is a novel reward regulator. Indeed, ghrelin signalling mediates the rewarding and motivational properties of addictive drugs. In addition, daily co-administration of a GHS-R1A antagonist and various addictive drugs prevents the drug-induced locomotor sensitization in rats.
Methods The present series of experiment were designed to evaluate the effect of repeated pharmacological GHS-R1A suppression on drug-induced locomotor stimulation in more detail.
Results We showed that sub-chronic pre-treatment of the GHS-R1A antagonist, JMV2959, attenuated the ability of acute administration of alcohol as well as of amphetamine to stimulate locomotion. However, there was no effect of sub-chronic JMV2959 treatment on locomotor activity per se or on the expression of the GHS-R1A gene ( Ghsr ) in the VTA or the NAc compared with vehicle treatment. In addition, sub-chronic ghrelin treatment caused a locomotor sensitization.
Conclusions While previous research has pinpointed ghrelin as an appetite regulator the present study together with previous studies suggest that ghrelin signalling modulates various reward-mediated behaviours in rodents. Collectively, this suggests that the GHS-R1A could be a key target for novel treatment strategies for addiction.
TL;DR: Policies that increase the cost of the cheapest alcohol can be effective in reducing alcohol consumption, without having highly regressive effects.
Abstract: Aims To compare estimated effects of two policy alternatives, (i) a minimum unit price (MUP) for alcohol and (ii) specific (per-unit) taxation, upon current product prices, per capita spending (A$), and per capita consumption by income quintile, consumption quintile and product type.
Methods Estimation of baseline spending and consumption, and modelling policy-to-price and price-to-consumption effects of policy changes using scanner data from a panel of demographically representative Australian households that includes product-level details of their off-trade alcohol spending ( n = 885; total observations = 12,505). Robustness checks include alternative price elasticities, tax rates, minimum price thresholds and tax pass-through rates.
Results Current alcohol taxes and alternative taxation and pricing policies are not highly regressive. Any regressive effects are small and concentrated among heavy consumers. The lowest-income consumers currently spend a larger proportion of income (2.3%) on alcohol taxes than the highest-income consumers (0.3%), but the mean amount is small in magnitude [A$5.50 per week (95%CI: 5.18–5.88)]. Both a MUP and specific taxation will have some regressive effects, but the effects are limited, as they are greatest for the heaviest consumers, irrespective of income. Among the policy alternatives, a MUP is more effective in reducing consumption than specific taxation, especially for consumers in the lowest-income quintile: an estimated mean per capita reduction of 11.9 standard drinks per week (95%CI: 11.3–12.6).
Conclusion Policies that increase the cost of the cheapest alcohol can be effective in reducing alcohol consumption, without having highly regressive effects.
TL;DR: Significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people are reported, with different influences found at different stages of alcohol use.
Abstract: Aims To conduct a systematic review of studies exploring the relationship between exposure to Internet-based alcohol-related content and alcohol use among young people.
Methods Searches of electronic databases and reference lists of relevant articles were conducted to retrieve studies of relevance up until December 2015. Full texts of the studies that met the inclusion criteria were read, appraised for quality using the Kmet forms and guidelines, and included in this review.
Results Fifteen relevant studies were identified. The included studies were a mix of cross-sectional, longitudinal, experimental and qualitative studies conducted in the USA, the UK, Australia and New Zealand. The age range of the participants involved in these studies was 12–25 years. Included studies employed a variety of study designs and a range of different exposure variables and outcome measures. Studies demonstrated significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people.
Conclusion Exposure to alcohol-related content on the Internet might predispose young people to patterns of alcohol use by promoting alcohol as a natural and vital part of life. However, the research exploring the influence of this novel form of advertising on young people's alcohol use is emergent, and comprised primarily of cross-sectional studies. To evaluate the direction of the association between exposure to online alcohol-related content and alcohol use, we call for further research based on longitudinal designs.
Short summary From 15 relevant studies identified, this review reports significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people, with different influences found at different stages of alcohol use.
TL;DR: T5342126, an experimental TLR4 inhibitor, is effective in reducing ethanol drinking and inhibiting the activation and proliferation of microglia in both ethanol-dependent and non-dependent mice, but its use as a potential candidate for the treatment of alcohol addiction may be limited due to its non-specific effects.
Abstract: Aims Several lines of evidence support a critical role of TLR4 in the neuroimmune responses associated with alcohol disorders and propose inhibitors of TLR4 signaling as potential treatments for alcoholism. In this work, we investigated the effect of T5342126 compound, a selective TLR4 inhibitor, on excessive drinking and microglial activation associated with ethanol dependence.
Methods We used 2BC-CIE (two-bottle choice-chronic ethanol intermittent vapor exposure) paradigm to induce ethanol dependence in mice. After induction of the ethanol dependence, we injected T5342126 (i.p., 57 mg/kg) for 14 days while monitoring ethanol intake by 2BC (limited access to ethanol) method.
Results T5342126 decreased ethanol drinking in both ethanol-dependent and non-dependent mice but T5342126 showed also dose-dependent non-specific effects represented by decreased animal locomotor activity, saccharine intake, and body core temperature. Six days after the last ethanol-drinking session, we examined the immunohistochemical staining of Iba-1 (ionized calcium-binding adapter molecule 1), a microglial activation marker, in the central nucleus of the amygdala (CeA) and dentate gyrus (DG) of the hippocampus. Notably, T5342126 reduced Iba-1 density in the CeA of both ethanol-dependent and non-dependent mice injected with T5342126. There were no significant differences in the DG Iba-1 density among the treatment groups.
Conclusions Collectively, our data suggest that T5342126, via blocking TLR4 activation, contributes to the reduction of ethanol drinking and ethanol-induced neuroimmune responses. However, the non-specific effects of T5342126 may play a significant role in the T5342126 effects on ethanol drinking and thus, may limit its therapeutic potential for treatment of alcohol dependence.
Short summary T5342126, an experimental TLR4 inhibitor, is effective in reducing ethanol drinking and inhibiting the activation and proliferation of microglia in both ethanol-dependent and non-dependent mice. However, T5342126's use as a potential candidate for the treatment of alcohol addiction may be limited due to its non-specific effects.
TL;DR: Overall data depict that moderate alcohol intake is also hepatotoxic and decreases intestinal absorption, however, TCE treatment effectively increased the intestinal absorption and retaining power of liver that regulated alcohol-induced multivitamin deficiency.
Abstract: Aims Heavy alcohol intake depletes the plasma vitamins due to hepatotoxicity and decreased intestinal absorption. However, moderate alcohol intake is often thought to be healthy. Therefore, effects of chronic moderate alcohol intake on liver and intestine were studied using urinary vitamin levels. Furthermore, effects of Tinospora cordifolia water extract (TCE) (hepatoprotective) on vitamin excretion and intestinal absorption were also studied.
Methods In the study, asymptomatic moderate alcoholics ( n = 12) without chronic liver disease and healthy volunteers ( n = 14) of mean age 39 ± 2.2 (mean ± SD) were selected and divided into three groups. TCE treatment was performed for 14 days. The blood and urine samples were collected on Day 0 and 14 after treatment with TCE and analyzed.
Results In alcoholics samples, a significant increase in the levels of gamma-glutamyl transferase, aspartate transaminase, alanine transaminase, Triglyceride, Cholesterol, HDL and LDL ( P < 0.05) was observed but their level get downregulated after TCE intervention. Multivariate analysis of metabolites without missing values showed an increased excretion of 7-dehydrocholesterol, orotic acid, pyridoxine, lipoamide and niacin and TCE intervention depleted their levels ( P < 0.05). In contrast, excretion of biotin, xanthine, vitamin D2 and 2- O - p -coumaroyltartronic acid (CA, an internal marker of intestinal absorption) were observed to be decreased in alcoholic samples; however, TCE intervention restored the CA and biotin levels. Vitamin metabolism biomarkers, i.e. homocysteine and xanthurenic acid, were also normalized after TCE intervention.
Conclusion Overall data depict that moderate alcohol intake is also hepatotoxic and decreases intestinal absorption. However, TCE treatment effectively increased the intestinal absorption and retaining power of liver that regulated alcohol-induced multivitamin deficiency.
TL;DR: The efficacy of emailed interventions differing by message framing and temporal context on alcohol involvement among heavy drinking college students is compared and need for cognition (NFC), consideration of future consequences (CFC) and self-efficacy as putative moderators are examined.
Abstract: AIMS: Only one study has examined message framing on college drinking, but did so in a laboratory setting among a general sample of college students. The current study was designed to: (a) compare the efficacy of emailed interventions differing by message framing and temporal context on alcohol involvement among heavy drinking college students and (b) examine need for cognition (NFC), consideration of future consequences (CFC) and self-efficacy as putative moderators. METHODS: Hazardous drinking college students (N = 220) were randomly assigned to conditions in a 2 (Frame: gain vs. loss) × 2 (Temporal Context: long-term vs. short-term consequences) factorial design. Participants received four emails on heavy drinking consequences phrased in a manner consistent with their condition. After each message, participants were given a manipulation check. Participants were sent a 1-month follow-up assessment. Primary outcome measures were heavy episodic drinking (HED) and alcohol-related problems. We hypothesized two main effects (less alcohol consumption in the gain-frame and short-term condition), qualified by a Frame × Temporal Context interaction with substantially less alcohol involvement in the gain-frame/short-term condition. RESULTS: There was very little study attrition (96.4% completed follow-up survey, 93.2-99.5% completed manipulation checks), and strong effects were observed for the manipulations. A 2 × 2 ANCOVA, controlling for baseline alcohol involvement, revealed no consistent main effects or interactions on either outcome. No moderation was observed for any putative moderator. CONCLUSIONS: These results do not replicate prior laboratory-based research. The null findings may be attributed to the heavy drinking sample or electronic means of message delivery. Language: en
TL;DR: These results provide support for integrated care in improving drinking outcomes for patients with alcohol dependence and comorbid depression/anxiety disorder.
Abstract: Aim To assess the effectiveness of a 12 week specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting.
Methods Out of 86 patients meeting the inclusion criteria for alcohol dependence with suspicion of comorbid anxiety and/or depressive disorder, 57 completed a 3-week stabilization period (abstinence or significantly reduced consumption). Of these patients, 37 (65%) met a formal diagnostic assessment of an anxiety and/or depressive disorder and were randomized to either (a) integrated intervention (cognitive behavioural therapy) for alcohol, anxiety and/or depression, or (b) usual counselling care for alcohol problems.
Results Intention-to-treat analyses revealed a beneficial treatment effect of integrated treatment relative to usual counselling care for the number of days to relapse ( χ 2 = 6.42, P < 0.05) and lapse ( χ 2 = 10.73, P < 0.01). In addition, there was a significant interaction effect of treatment and time for percentage days of abstinence ( P < 0.05). For heavy drinking days, the treatment effect was mediated by changes in DASS anxiety ( P < 0.05). There were no significant treatment interaction effects for DASS depression or anxiety symptoms.
Conclusions These results provide support for integrated care in improving drinking outcomes for patients with alcohol dependence and comorbid depression/anxiety disorder.
Trial Registration ClinicalTrials.gov Identifier: [NCT01941693][1].
[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01941693&atom=%2Falcalc%2F51%2F4%2F402.atom
TL;DR: It is demonstrated for the first time that alcohol-dependent patients have stronger alcohol-approach association scores on the Implicit Association Test as compared to controls, and that this bias is associated with drinking behavior.
Abstract: Aims There is accumulating evidence that automatic processes play a large role in alcohol dependence, which may be related to alcohol craving and consumption. The aim of this study is to investigate associations between cognitive biases in alcohol-dependent patients, and how these measures relate to drinking behavior.
Methods Thirty alcohol-dependent patients and 15 healthy controls (matched for age, intelligence and education; all male) completed three cognitive bias tasks: the Implicit Association Test (IAT: alcohol-approach association), Approach Avoidance Task (AAT: alcohol approach bias) and Dot Probe Task (DPT: alcohol attentional bias). Task scores were compared between groups and correlated with each other, as well as with craving scores and drinking behavior.
Results Patients with alcohol dependence showed stronger alcohol-approach associations on the IAT compared with controls, but there were no group differences for approach or attentional biases. Within the patient group, the alcohol approach bias (AAT) correlated positively with the attend-alcohol attentional bias (DPT), but negatively with alcohol-approach associations (IAT). IAT scores were positively associated with lifetime alcohol intake.
Conclusions This study demonstrates for the first time that alcohol-dependent patients have stronger alcohol-approach association scores on the IAT as compared to controls, and that this bias is associated with drinking behavior. Despite the absence of group differences for the approach and attentional biases, the positive correlation between these biases in alcoholics is in line with incentive salience models of addiction that propose that attentional and approach tendencies have a common underlying mechanism, distinct from that underlying alcohol-approach associations measured by the IAT.
Short Summary The study investigates associations between cognitive biases involving alcohol cues. Patients with alcohol dependence showed stronger alcohol-approach associations on an Implicit Association Test than controls, but there were no group differences for approach or attentional biases. Alcohol-approach and attentional bias correlated positively in the patient group.
TL;DR: Alcohol use after LT is independent of LT indication and patients with non-ALD etiology should be carefully screened for alcohol use prior to LT to identify those at risk for post-LT alcohol use.
Abstract: Aim To assess alcohol use after liver transplantation (LT) and compare liver transplant recipients for alcoholic liver disease (ALD) with recipients for non-ALD causes.
Methods National Institute of Diabetes and Digestive and Kidney Diseases liver transplant database stratified to ALD and non-ALD causes.
Results Among 488 LT recipients reporting pre-transplant alcohol use (147 ALD), proportion of LT recipients reporting alcohol use was similar comparing ALD and non-ALD transplants (25.4% vs. 27.2%; P = 0.56). Among ALD transplants, of 31 with alcohol use, 23 (74%) relapsed at ≥2 year, 25 (80%) reported intermittent drinking and 4 (13%) reported heavy drinking. Among Non-ALD recipients, alcohol use was equally distributed to within 2, 2–5 and after 5 years of LT with 82% reporting intermittent drinking and 9% heavy drinking. Patients with pre-transplant drinking of >20 years and abstinence duration of 20 years and abstinence of >2 years, 2.56 [95% CI: 1.41–4.67]. Etiology (ALD vs. non-ALD) did not predict post-transplant alcohol use. Of 139 ALD patients with follow-up biopsy data, 13 (7 with post-transplant alcohol use) had steatohepatitis. Histology on 319 non-ALD recipients showed recurrent disease in 91, none due to alcohol. Overall survival was similar between drinkers and abstainers (71% vs. 66%; P = 0.35). Recurrent ALD was cause of death in one ALD and none of non-ALD patients.
Conclusion Alcohol use after LT is independent of LT indication. Patients with non-ALD etiology should be carefully screened for alcohol use prior to LT to identify those at risk for post-LT alcohol use.
TL;DR: English national surveys have been inconsistent over time in including questions that provide information on average volume of consumption but have not included questions on another essential alcohol consumption measure, frequency of heavy episodic drinking, which has contributed to the inadequacy of survey measurements for monitoring vital aspects of alcohol consumption in England over recent years.
Abstract: Aims: To review the international guidelines and recommendations on survey instruments for measurement of alcohol consumption in population surveys, and to examine how national surveys in England meet the core recommendations.
Methods: A systematic search for international guidelines for measuring alcohol consumption in population surveys was undertaken. The common core recommendations for alcohol consumption measures and survey instruments were identified. Alcohol consumption questions in national surveys in England were compared with these recommendations for specific years and over time since 2000.
Results: Four sets of international guidelines and three core alcohol consumption measures (alcohol consumption status, average volume of consumption, frequency and volume of binge drinking) with another optional measure (drinking context) were identified. English national surveys have been inconsistent over time in including questions that provide information on average volume of consumption but have not included questions on another essential alcohol consumption measure, frequency of heavy episodic drinking. Instead they have used questions that focus only on maximum volume of alcohol consumed on any day in the previous week.
Conclusions: International guidelines provide consistent recommendations for measuring alcohol consumption in population surveys. These recommendations have not been consistently applied in English national surveys and this has contributed to the inadequacy of survey measurements for monitoring vital aspects of alcohol consumption in England over recent years.
TL;DR: The association between this exposure and adolescents' drinking was robust and seems consistent across national contexts and active engagement with online alcohol Marketing was found to interact more strongly with drinking outcomes than passive exposure to online alcohol marketing.
Abstract: Aims The Internet is the leading medium among European adolescents in contemporary times; even more time is spent on the Internet than watching television. This study investigates associations between online alcohol marketing exposure and onset of drinking and binge drinking among adolescents in four European countries.
Method A total of 9038 students with a mean age of 14.05 (SD 0.82) participated in a school-based survey in Germany, Italy, the Netherlands and Poland. Logistic regression analyses of cross-sectional cross-country survey data were undertaken. Exposure to online alcohol marketing, televised alcohol advertising and ownership of alcohol-branded items was estimated to be controlled for relevant confounders. Onset of drinking and binge drinking in the past 30 days were included in the study as outcome variables.
Results Adjusted for relevant confounders, higher exposure to (online) alcohol marketing exposure was found to be related to the odds of starting to drink ( p < 0.001) and the odds of binge drinking in the past 30 days ( p < 0.001). This effect was found to be consistent in all four countries. Active engagement with online alcohol marketing was found to interact more strongly with drinking outcomes than passive exposure to online alcohol marketing.
Conclusions Youngsters in the four European countries report frequent exposure to online alcohol marketing. The association between this exposure and adolescents’ drinking was robust and seems consistent across national contexts.
TL;DR: Self-reports of quantity of alcohol consumed in terms of standard drinks had predictive validity for blood pressure and hypertension even in rural areas, however, using detailed measures of consumption resulted in only minor improvements in prediction compared to simple measures.
Abstract: Aims To provide nationally representative data on alcohol consumption in Vietnam and to assess whether reported numbers of ‘standard drinks’ consumed have evidence of validity (particularly in rural areas where home-made alcohol is consumed from cups of varying size).
Methods A nationally representative population-based survey of 14,706 participants (46.5% males, response proportion 64.1%) aged 25−64 years in Vietnam. Measurements were made in accordance with WHO STEPS protocols. Data were analysed using complex survey methods.
Results Among men, 80% reported drinking alcohol during the last year, and 40% were hazardous/harmful drinkers. Approximately 60% of men and <5% of women had consumed alcohol during the last week, with one-in-four of the men reporting having consumed at least five standard drinks on at least one occasion. Numbers of standard drinks reported by men were associated with blood pressure/hypertension, particularly in rural areas ( P < 0.001 for trend). Most of the calibration and discrimination possible from self-reported information on alcohol consumption was provided by binary responses to questions on whether or not alcohol had been consumed during the reference period.
Conclusion Alcohol use and harmful consumption were common among Vietnamese men but less pronounced than in Western nations. Self-reports of quantity of alcohol consumed in terms of standard drinks had predictive validity for blood pressure and hypertension even in rural areas. However, using detailed measures of consumption resulted in only minor improvements in prediction compared to simple measures.
TL;DR: It is concluded that ethanol consumption induces the expression of different proteins that regulate vascular contraction and growth and that NADPH oxidase-derived ROS play a role in such response.
Abstract: Aims Investigate the role of NADPH oxidase on ethanol - induced hypertension and vascular oxidative stress.
Methods Male Wistar rats were treated with ethanol (20% v/v).
Results Apocynin (10 mg/kg/day, i.p. ) prevented ethanol-induced hypertension. The increased contractility of endothelium-intact and endothelium-denuded aortic rings from ethanol-treated rats to phenylephrine was prevented by apocynin. Ethanol consumption increased superoxide anion (O2 −) generation and lipid peroxidation and apocynin prevented these responses. The decrease on plasma and vascular nitrate/nitrite (NOx) levels induced by ethanol was not prevented by apocynin. Treatment with ethanol did not affect aortic levels of hydrogen peroxide (H2O2) or reduced glutathione (GSH). Ethanol did not alter the activities of xanthine oxidase (XO), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Ethanol increased the expression of Nox1, PKCδ, nNOS, SAPK/JNK and SOD2 in the rat aorta and apocynin prevented these responses. No difference on aortic expression of Nox2, Nox4, p47phox, Nox organizer 1 (Noxo1), eNOS and iNOS was detected after treatment with ethanol. Ethanol treatment did not alter the phosphorylation of SAPK/JNK, p38MAPK, c-Src, Rac1 or PKCδ.
Conclusions The major new finding of our study is that the increased vascular generation of reactive oxygen species (ROS) induced by ethanol is related to increased vascular Nox1/NADPH oxidase expression. This mechanism is involved in vascular dysfunction and hypertension induced by ethanol. Additionally, we conclude that ethanol consumption induces the expression of different proteins that regulate vascular contraction and growth and that NADPH oxidase-derived ROS play a role in such response.
Short summary The key findings of our study are that ethanol-induced hypertension is mediated by NADPH oxidase. Moreover, increased vascular Nox1 expression is related to the generation of reactive oxygen species (ROS) by ethanol. Finally, ROS induced by ethanol increase the expression of the regulatory vascular proteins.
TL;DR: Initial results are encouraging and highlight the PEth-DBS potential in retrospective assessment of alcohol exposure in newborns suspected of FASD, especially when stored at lower temperatures.
Abstract: Background The analysis of phosphatidylethanol, a promising direct ethanol metabolite, in dry blood spots (PEth-DBS) is advantageous due to ease of storage, transportation and minimal invasiveness of capillary blood collection. One potential application of PEth-DBS is to confirm prenatal alcohol exposure in newborns suspected of FASD; however, stability of PEth-DBS is largely unknown.
Methods Phlebotomized samples from 31 adults with a history of alcoholism, admitted to the University of New Mexico Emergency Department, were analyzed for blood alcohol content and pipetted onto DBS cards (13 spots per patient). The first spot was analyzed within 2 weeks of collection for a baseline PEth; the remaining 12 spots were allocated into three temperature conditions (room temperature, 4°C, −80°C) for the repeated measures analysis. In addition, 5 newborn DBS samples with a baseline PEth>LOD were obtained from a prospective cohort at UNM and re-analyzed at 4 months after storage at −80°C. A mixed linear model was fitted to examine the effects of temperature, time and temperature–time interaction on PEth degradation over the first 9 months.
Results The baseline PEth levels were 592.8 ± 86.7 ng/ml and 18.3 ± 4.8 ng/ml in adult and newborn samples, respectively. All DBS samples remained positive in successive samples in all temperature conditions. Results of mixed linear model demonstrated a significant effect of temperature ( P < 0.001) on PEth degradation over 9 months.
Conclusions PEth-DBS appears to be relatively stable, especially when stored at lower temperatures. These initial results are encouraging and highlight the PEth-DBS potential in retrospective assessment of alcohol exposure.
TL;DR: The findings of this study demonstrate the need for further research into the complex interaction between social networking and alcohol consumption, and add support to calls for effective regulation of alcohol marketing on social network platforms.
Abstract: Aims To examine the association of alcohol-brand social networking pages and Facebook users' drinking attitudes and behaviours.
Methods Cross-sectional, self-report data were obtained from a convenience sample of 283 Australian Facebook users aged 16–24 years via an online survey.
Results More than half of the respondents reported using Facebook for more than an hour daily. While only 20% had actively interacted with an alcohol brand on Facebook, we found a significant association between this active interaction and alcohol consumption, and a strong association between engagement with alcohol brands on Facebook and problematic drinking.
Conclusions The findings of this study demonstrate the need for further research into the complex interaction between social networking and alcohol consumption, and add support to calls for effective regulation of alcohol marketing on social network platforms.