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1.  THE RELATIONSHIP BETWEEN MEASURES OF IMPULSIVITY AND ALCOHOL MISUSE: AN INTEGRATIVE STRUCTURAL EQUATION MODELING APPROACH 
Background
Higher levels of impulsivity have been implicated in the development of alcohol use disorders. Recent findings suggest that impulsivity is not a unitary construct, highlighted by the diverse ways in which the various measures of impulsivity relate to alcohol use outcomes. This study simultaneously tested the following dimensions of impulsivity as determinants of alcohol use and alcohol problems: risky decision-making, self-reported risk attitudes, response inhibition, and impulsive decision-making.
Method
Participants were a community sample of non-treatment seeking problem drinkers (N = 158). Structural Equation Modeling (SEM) analyses employed behavioral measures of impulsive decision-making (Delay Discounting Task, DDT), response inhibition (Stop Signal Task, SST), and risky decision-making (Balloon Analogue Risk Task, BART), and a self-report measure of risk attitudes (Domain-specific Risk-attitude Scale, DOSPERT), as predictors of alcohol use and of alcohol-related problems in this sample.
Results
The model fit well, accounting for 38% of the variance in alcohol problems, and identified two impulsivity dimensions that significantly loaded onto alcohol outcomes: (1) impulsive decision-making, indexed by the DDT; and (2) risky decision-making, measured by the BART.
Conclusions
The impulsive decision-making dimension of impulsivity, indexed by the DDT, was the strongest predictor of alcohol use and alcohol pathology in this sample of problem drinkers. Unexpectedly, a negative relationship was found between risky decision-making and alcohol problems. The results highlight the importance of considering the distinct facets of impulsivity in order to elucidate their individual and combined effects on alcohol use initiation, escalation, and dependence.
doi:10.1111/j.1530-0277.2011.01635.x
PMCID: PMC3291799  PMID: 22091877
impulsivity; alcohol use; alcohol problems; delayed reward discounting; risk-taking
2.  Anxiety, Sedation, and Simulated Driving in Binge Drinkers 
The current study evaluated the relationships among trait anxiety, subjective response to alcohol, and simulated driving following a simulated alcohol binge. Sixty drinkers with a binge history completed the State Trait Anxiety Inventory (STAI), the Alcohol Use Questionnaire, and subsequently completed a driving simulation. Participants were then administered 0.2 g/kg ethanol at 30 minute intervals (cumulative dose 0.8 g/kg). Following alcohol consumption, the Biphasic Alcohol Effects Scale (BAES) and visual analog scales of subjective impairment and driving confidence were administered, after which simulated driving was re-assessed. Due to the emphasis on simulated driving after drinking in the current study, subjective response to alcohol (i.e., self-reported sedation, stimulation, impairment, and confidence in driving ability) was assessed once following alcohol consumption, as this is the time when drinkers tend to make decisions regarding legal driving ability. Alcohol increased driving speed, speeding tickets, and collisions. Sedation following alcohol predicted increased subjective impairment and decreased driving confidence. Subjective impairment was not predicted by sensitivity to stimulation or trait anxiety. High trait anxiety predicted low driving confidence after drinking and this relationship was mediated by sedation. Increased speed after alcohol was predicted by sedation, but not by trait anxiety or stimulation. Anxiety, combined with the sedating effects of alcohol, may indicate when consumption should cease. However, once driving is initiated, sensitivity to sedation following alcohol consumption is positively related to simulated driving speed.
doi:10.1037/a0036511
PMCID: PMC4170799  PMID: 24955664
alcohol drinking; simulated driving; anxiety; biphasic alcohol effects
3.  Effects of energy drinks mixed with alcohol on behavioral control: Risks for college students consuming trendy cocktails 
Background
There has been a dramatic rise in the consumption of alcohol mixed with energy drinks (AmED) in young people. AmEDs have been implicated in risky drinking practices and greater accidents and injuries have been associated with their consumption. Despite the increased popularity of these beverages (e.g., Red Bull and vodka), there is little laboratory research examining how the effects of AmED differ from alcohol alone. This experiment was designed to investigate if the consumption of AmED alters neurocognitive and subjective measures of intoxication compared with the consumption of alcohol alone.
Methods
Participants (n=56) attended one session where they were randomly assigned to receive one of four doses (0.65 g/kg alcohol, 3.57 ml/kg energy drink, AmED or a placebo beverage). Performance on a cued go/no-go task was used to measure the response of inhibitory and activational mechanisms of behavioral control following dose administration. Subjective ratings of stimulation, sedation, impairment and level of intoxication were recorded.
Results
Alcohol alone impaired both inhibitory and activational mechanisms of behavioral control, as evidenced by increased inhibitory failures and increased response times compared to baseline performance. Coadministration of the energy drink with alcohol counteracted some of the alcohol-induced impairment of response activation, but not response inhibition. For subjective effects, alcohol increased ratings of stimulation, feeling the drink, liking the drink, impairment and level of intoxication and alcohol decreased the rating of ability to drive. Coadministration of the energy drink with alcohol increased self-reported stimulation, but resulted in similar ratings of the other subjective effects as when alcohol was administered alone.
Conclusions
An energy drink appears to alter some of alcohol’s objective and subjective impairing effects, but not others. Thus AmEDs may contribute to a high risk scenario for the drinker. The mix of impaired behavioral inhibition and enhanced stimulation is a combination that may make AmED consumption riskier than alcohol consumption alone.
doi:10.1111/j.1530-0277.2011.01464.x
PMCID: PMC3117195  PMID: 21676002
alcohol; energy drink; behavioral control; reaction time; stimulation
4.  Alcohol-induced risk taking on the BART mediates alcohol priming 
Psychopharmacology  2013;231(11):2273-2280.
Rationale
Hazardous drinking has been associated with risk taking and alcohol priming effects. However, the potential relationship between risk taking and priming has not been investigated. The Balloon Analogue Risk Task (BART) is a behavioural measure of risk taking which appears to be associated with drinking behaviour. However, alcohol's acute effects on BART performance are not clear, and the potentially mediating effect of alcohol-induced risk taking on priming has not been tested.
Objectives
To assess the effects of a priming dose of alcohol on BART performance; to determine the predictive utility of the BART on drinking habits; and to identify whether alcohol-induced risk taking mediates alcohol priming (urge to drink).
Methods
A total of 142 participants provided data on drinking habits and trait-like impulsivity and sensation seeking. The BART was then completed after consuming alcohol (0.6 g/kg) or placebo (between-subjects design). Baseline and post-drink measures of alcohol urge were also taken.
Results
Alcohol consumption increased urge to drink (priming) and risk taking on the BART. In the alcohol group only, risk taking on the BART predicted unique variance in weekly alcohol consumption and bingeing. Mediation analysis showed that risk taking following alcohol consumption mediated alcohol priming.
Conclusions
This is the first study to show that alcohol acutely increases risk taking on the BART. Results suggest that social drinkers susceptible to alcohol-induced risk taking may be more likely to drink excessively, perhaps due to increased urge to drink (priming).
Electronic supplementary material
The online version of this article (doi:10.1007/s00213-013-3377-1) contains supplementary material, which is available to authorized users.
doi:10.1007/s00213-013-3377-1
PMCID: PMC4018511  PMID: 24337024
Alcohol; BART; Risk taking; Intoxication; Priming; Urge; Social drinkers
5.  Alcohol Increases Impulsivity and Abuse Liability in Heavy Drinking Women 
Heavy drinking has increased in recent years and has been linked to numerous health-related risks, particularly in women. A number of factors may play a role in exacerbating the risks linked to heavy drinking, such as impulsivity, which itself is related to a number of risky behaviors. The present study investigated the effects of alcohol (0, 0.5, 0.75 g/kg) on impulsivity in female heavy drinkers (n = 23) and female light drinkers (n = 23) using a double-blind, placebo-controlled outpatient design; all women were tested during follicular phase of the menstrual cycle. Each session, participants completed a range of tasks including subjective measures of abuse liability, cognitive performance tasks, three behavioral impulsivity tasks, and a risk-taking task. Alcohol increased impulsivity on the Immediate and Delayed Memory Task (IMT and DMT) and Delay Discounting task. Heavy drinkers scored higher on impulsivity self-reports and were more impulsive on the IMT and the GoStop task than light drinkers. The high dose of alcohol further increased impulsive performance on the IMT and DMT in heavy drinkers. There were no group differences or alcohol effects on the Balloon Analogue Risk Task. Alcohol increased sedative-like effects more in light drinkers and increased stimulant-like effects and alcohol liking more in heavy drinkers. In summary, female heavy drinkers are less sensitive to the negative effects of alcohol, report more positive effects of alcohol, and are more impulsive than female light drinkers. Moreover, impulsive responding was exacerbated by alcohol drinking among female heavy drinkers, indicating that women who drink at this level are at increased risk for developing alcohol use disorders and engaging in other risky behaviors, particularly after drinking.
doi:10.1037/a0029087
PMCID: PMC3598581  PMID: 23066857
impulsivity; alcohol; abuse liability; heavy drinking; women
6.  Acute alcohol effects on impulsivity: Associations with drinking and driving behavior 
Addiction (Abingdon, England)  2012;107(12):2109-2114.
Aims
Although drink drivers exhibit higher levels of trait impulsivity, no studies have tested the hypothesis that drink drivers experience increased impulsivity while intoxicated. We tested this hypothesis for two impulsivity constructs: delay discounting and behavioral inhibition.
Design
A within-subjects study comparing performance of drink drivers and non-drink drivers on behavioral measures of impulsivity in alcohol and no-beverage sessions.
Setting
A laboratory setting at the University of Missouri.
Participants
Twenty-nine young adults who were at least moderate drinkers were recruited from the local community and the University of Missouri.
Measurements
Impulsivity was assessed using the Two Choice Impulsivity Paradigm (TCIP) and the Stop-Signal Task. Participants also completed self-report measures of binge drinking and trait impulsivity.
Findings
In the no-beverage session, TCIP impulsive choices did not differ between drinking and driving groups (p = .93). In the alcohol session, drink drivers made more TCIP impulsive choices on both the ascending (p < .01) and descending limb (p < .01) of the blood alcohol concentration curve than their peers who did not drink and drive. Drinking and driving groups did not differ on the Stop-Signal Task. Supplementary analyses indicated that effects for the TCIP were not explained by individual differences in trait impulsivity.
Conclusions
Individuals who report having three or more drinks before driving show greater impulsivity when under the influence of alcohol than those who do not report heavy drinking before driving.
doi:10.1111/j.1360-0443.2012.03974.x
PMCID: PMC3449018  PMID: 22690907
7.  A Population-Based Study on Alcohol and High-Risk Sexual Behaviors in Botswana 
PLoS Medicine  2006;3(10):e392.
Background
In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.
Methods and Findings
We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design. Multivariate logistic regression was used to assess correlates of heavy alcohol consumption (>14 drinks/week for women, and >21 drinks/week for men) as a dependent variable. We also assessed gender-specific associations between alcohol use as a primary independent variable (categorized as none, moderate, problem and heavy drinking) and several risky sex outcomes including: (a) having unprotected sex with a nonmonogamous partner; (b) having multiple sexual partners; and (c) paying for or selling sex in exchange for money or other resources. Criteria for heavy drinking were met by 31% of men and 17% of women. Adjusted correlates of heavy alcohol use included male gender, intergenerational relationships (age gap ≥10 y), higher education, and living with a sexual partner. Among men, heavy alcohol use was associated with higher odds of all risky sex outcomes examined, including unprotected sex (AOR = 3.48; 95% confidence interval [CI], 1.65 to 7.32), multiple partners (AOR = 3.08; 95% CI, 1.95 to 4.87), and paying for sex (AOR = 3.65; 95% CI, 2.58 to 12.37). Similarly, among women, heavy alcohol consumption was associated with higher odds of unprotected sex (AOR = 3.28; 95% CI, 1.71 to 6.28), multiple partners (AOR = 3.05; 95% CI, 1.83 to 5.07), and selling sex (AOR = 8.50; 95% CI, 3.41 to 21.18). A dose-response relationship was seen between alcohol use and risky sexual behaviors, with moderate drinkers at lower risk than both problem and heavy drinkers.
Conclusions
Alcohol use is associated with multiple risks for HIV transmission among both men and women. The findings of this study underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.
Alcohol use is associated with multiple risks for HIV transmission in men and women. The findings underscore the need to integrate alcohol abuse and HIV prevention efforts in Botswana and elsewhere.
Editors' Summary
Background.
Human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS), is most commonly spread through unprotected sex with an infected partner. HIV enters the body through the lining of the sex organs, rectum, or mouth, and destroys immune system cells, leaving the infected person susceptible to other viruses and bacteria. Although HIV education and prevention campaigns emphasize the importance of safe sex in reducing HIV transmission, people continue to become infected by having unprotected sex (that is, not using a condom) with either a nonmonogamous partner or multiple sexual partners, or in situations where they are paying for or selling sex. Research in different populations suggested that heavy alcohol use is associated with risky sexual behaviors. This is because alcohol relaxes the brain and body, reduces inhibitions, and diminishes risk perception. Drinking alcohol may further increase the risk of becoming infected with HIV through its suppressive effects on the immune system.
Why Was This Study Done?
Alcohol abuse is widespread in sub-Saharan Africa where most HIV infections occur and has been associated with risky sexual behaviors. It may therefore be one of the most common, potentially modifiable HIV risk factors in this region. However, research to date has concentrated on the association between alcohol consumption and risky sex in people attending HIV-treatment clinics or recruited at beer halls, and these populations may not be representative of the general population of sub-Saharan Africa. In this study, the researchers have investigated the potential role of alcohol in perpetuating the HIV epidemic by undertaking a population-based study on alcohol use and high-risk sexual behaviors in Botswana. Nearly a quarter of adults are infected with HIV here, and alcohol abuse is also common, particularly in the townships.
What Did the Researchers Do and Find?
The researchers recruited a random cross-section of people from the five districts of Botswana with the highest number of HIV-infected individuals and interviewed all 1,268 participants using a questionnaire. This included general questions about the participants (for example, their age and marital status) and questions about alcohol use, sexual behavior, and knowledge of HIV. Overall, 31% of the men in the study and 17% of the women were heavy drinkers—more than 21 drinks/week for men, 14 for women; a drink is half a pint of beer or a glass of wine. Heavy alcohol use was associated with being male, being in an intergenerational relationship (at least 10 years age difference between partners; intergenerational sex facilitates the continued spread of HIV in sub-Saharan Africa), having had more education, and living with a sexual partner. Among men, those who drank heavily were three to four times more likely to have unprotected sex or multiple partners or to pay for sex than nondrinkers. Among women, there was a similar association between heavy drinking and having unprotected sex or multiple partners, and heavy drinkers were eight times as likely to sell sex as nondrinkers. For both men and women, the more they drank, the more likely they were to have risky sex. The study did not address behavior among same-sex partnerships.
What Do These Findings Mean?
This study indicates that heavy alcohol consumption is strongly and consistently associated with sexual risk behaviors in both men and women in Botswana. Because of the study design, it does not prove that heavy alcohol use is the cause of such behaviors but provides strong circumstantial evidence that this is the case. It is possible that these results may not apply to neighboring African countries—Botswana is unique in being relatively wealthy and in its government being strongly committed to tackling HIV. Nevertheless, taken together with the results of other studies, this research strongly argues for the need to deal with alcohol abuse within HIV prevention programs in sub-Saharan Africa. Strategies to do this could include education campaigns that target both alcohol use and HIV in schools and in social venues, including beer halls. But, stress the researchers, any strategy that is used must consider the cultural and social significance of alcohol use (in Botswana, alcohol use is a symbol of masculinity and high socioeconomic status) and must simultaneously tackle not only the overlap between alcohol use and risky sexual behavior but also the overlap between alcohol and other risk behaviors such as intergenerational sex.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030392.
US National Institute of Allergy and Infectious Diseases factsheet on HIV infection and AIDS
US Department of Health and Human Services information on AIDS
US Centers for Disease Control and Prevention information on HIV/AIDS
US National Institute on Alcohol Abuse and Alcoholism patient information on alcohol and HIV/AIDS]
Aidsmap, information on HIV and AIDS provided by the charity NAM,which includes some information on HIV infections and alcohol
AVERT information on HIV and AIDS in Botswana
doi:10.1371/journal.pmed.0030392
PMCID: PMC1592342  PMID: 17032060
8.  Can’t stop the craving: The effect of impulsivity on cue-elicited craving for alcohol in heavy and light social drinkers 
Psychopharmacology  2011;219(2):511-518.
Rationale
A robust finding in the alcohol literature is that heavy and alcohol-dependent drinkers show stronger reactions to alcohol-related cues than light drinkers. However, there are individual differences in the degree of cue-elicited craving. Personality factors appear to be involved in cue reactivity and impulsivity is a possible candidate.
Objectives
The aim of the present study was to examine the role of different aspects of impulsivity in heavy drinking and alcohol cue reactivity in social drinkers.
Methods
Participants were heavy (n = 13) and light (n = 29) social drinkers who were exposed to neutral and alcohol-related stimuli during a single laboratory session. Trait impulsivity, response inhibition, and sensitivity to reward were assessed with the Barratt Impulsiveness Scale (BIS-11), the Stop Signal Task, and the Card-Arranging Reward Responsivity Objective Test, respectively.
Results
Heavy drinkers scored higher on trait impulsivity (BIS-11) than light drinkers. In addition, heavy drinkers reported elevated levels of craving for alcohol, but both in light and heavy drinkers, craving increased equally after exposure to alcohol cues. Impulsivity appeared to moderate this relation: heavy drinkers with ineffective response inhibition showed more craving to alcohol cues, compared to heavy drinkers with adequate response inhibition. In light drinkers, response inhibition did not influence craving to alcohol cues.
Conclusions
Different aspects of impulsivity are involved in heavy drinking and perhaps motivate alcohol consumption in a variety of ways. Having a deficient response inhibition appears to be a risk factor for heavy drinkers because it is associated with increased craving to alcohol cues.
doi:10.1007/s00213-011-2240-5
PMCID: PMC3249167  PMID: 21384105
Cue reactivity; Craving; Alcohol cue exposure; Impulsivity; Response inhibition; Sensitivity to reward
9.  Alcohol Sales and Risk of Serious Assault 
PLoS Medicine  2008;5(5):e104.
Background
Alcohol is a contributing cause of unintentional injuries, such as motor vehicle crashes. Prior research on the association between alcohol use and violent injury was limited to survey-based data, and the inclusion of cases from a single trauma centre, without adequate controls. Beyond these limitations was the inability of prior researchers to comprehensively capture most alcohol sales. In Ontario, most alcohol is sold through retail outlets run by the provincial government, and hospitals are financed under a provincial health care system. We assessed the risk of being hospitalized due to assault in association with retail alcohol sales across Ontario.
Methods and Findings
We performed a population-based case-crossover analysis of all persons aged 13 years and older hospitalized for assault in Ontario from 1 April 2002 to 1 December 2004. On the day prior to each assault case's hospitalization, the volume of alcohol sold at the store in closest proximity to the victim's home was compared to the volume of alcohol sold at the same store 7 d earlier. Conditional logistic regression analysis was used to determine the associated relative risk (RR) of assault per 1,000 l higher daily sales of alcohol. Of the 3,212 persons admitted to hospital for assault, nearly 25% were between the ages of 13 and 20 y, and 83% were male. A total of 1,150 assaults (36%) involved the use of a sharp or blunt weapon, and 1,532 (48%) arose during an unarmed brawl or fight. For every 1,000 l more of alcohol sold per store per day, the relative risk of being hospitalized for assault was 1.13 (95% confidence interval [CI] 1.02–1.26). The risk was accentuated for males (1.18, 95% CI 1.05–1.33), youth aged 13 to 20 y (1.21, 95% CI 0.99–1.46), and those in urban areas (1.19, 95% CI 1.06–1.35).
Conclusions
The risk of being a victim of serious assault increases with alcohol sales, especially among young urban men. Akin to reducing the risk of driving while impaired, consideration should be given to novel methods of preventing alcohol-related violence.
In a population-based case-crossover analysis, Joel Ray and colleagues find that the risk of being a victim of serious assault increases with retail alcohol sales, especially among young urban men.
Editors' Summary
Background.
Alcohol has been produced and consumed around the world since prehistoric times. In the Western world it is now the most commonly consumed psychoactive drug (a substance that changes mood, behavior, and thought processes). The World Health Organization reports that there are 76.3 million persons with alcohol use disorders worldwide. Alcohol consumption is an important factor in unintentional injuries, such as motor vehicle crashes, and in violent criminal behavior. In the United Kingdom, for example, a higher proportion of heavy drinkers than light drinkers cause violent criminal offenses. Other figures suggest that people (in particular, young men) have an increased risk of committing a criminally violent offense within 24 h of drinking alcohol. There is also some evidence that suggests that the victims as well as the perpetrators of assaults have often been drinking recently, possibly because alcohol impairs the victim's ability to judge potentially explosive situations.
Why Was This Study Done?
The researchers wanted to know more about the relationship between alcohol and intentional violence. The recognition of a clear link between driving when impaired by alcohol and motor vehicle crashes has led many countries to introduce public awareness programs that stigmatize drunk driving. If a clear link between alcohol consumption by the people involved in violent crime could also be established, similar programs might reduce alcohol-related assaults. The researchers tested the hypothesis that the risk of being hospitalized due to a violent assault increases when there are increased alcohol sales in the immediate vicinity of the victim's place of residence.
What Did the Researchers Do and Find?
The researchers did their study in Ontario, Canada for three reasons. First, Ontario is Canada's largest province. Second, the province keeps detailed computerized medical records, including records of people hospitalized from being violently assaulted. Third, most alcohol is sold in government-run shops, and the district has the infrastructure to allow daily alcohol sales to be tracked. The researchers identified more than 3,000 people over the age of 13 y who were hospitalized in the province because of a serious assault during a 32-mo period. They compared the volume of alcohol sold at the liquor store nearest to the victim's home the day before the assault with the volume sold at the same store a week earlier (this type of study is called a “case-crossover” study). For every extra 1,000 l of alcohol sold per store per day (a doubling of alcohol sales), the overall risk of being hospitalized for assault increased by 13%. The risk was highest in three subgroups of people: men (18% increased risk), youths aged 13 to 20 y (21% increased risk), and those living in urban areas (19% increased risk). At peak times of alcohol sales, the risk of assault was 41% higher than at times when alcohol sales were lowest.
What Do These Findings Mean?
These findings indicate that the risk of being seriously assaulted increases with the amount of alcohol sold locally the day before the assault and show that the individuals most at risk are young men living in urban areas. Because the study considers only serious assaults and alcohol sold in shops (i.e., not including alcohol sold in bars), it probably underestimates the association between alcohol and assault. It also does not indicate whether the victim or perpetrator of the assault (or both) had been drinking, and its findings may not apply to countries with different drinking habits. Nevertheless, these findings support the idea that the consumption of alcohol contributes to the occurrence of medical injuries from intentional violence. Increasing the price of alcohol or making alcohol harder to obtain might help to reduce the occurrence of alcohol-related assaults. The researchers suggest that a particularly effective approach may be to stigmatize alcohol-related brawling, analogous to the way that driving under the influence of alcohol has been made socially unacceptable.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050104.
This study is further discussed in a PLoS Medicine Perspective by Bennetts and Seabrook
The US National Institute on Alcohol Abuse and Alcoholism provides information on all aspects of alcohol abuse, including an article on alcohol use and violence among young adults
Alcohol-related assault is examined in the British Crime Survey
Alcohol Concern, the UK national agency on alcohol misuse, provides fact sheets on the health impacts of alcohol, young people's drinking, and alcohol and crime
The Canadian Centre for Addiction and Mental Health in Toronto provides information about alcohol addiction (in English and French)
doi:10.1371/journal.pmed.0050104
PMCID: PMC2375945  PMID: 18479181
10.  Bidirectional interactions between acute psychosocial stress and acute intravenous alcohol in healthy men 
Background
The biological mechanisms by which acute stress increases alcohol consumption are unclear. One potential mechanism is that stress acts by altering the pharmacological and subjective effects of alcohol. Acute stress produces a cascade of physiological and psychological effects, each with a distinctive time course. In this study, we investigated whether different phases of response to an acute stress alter the subjective effects of intravenous alcohol, by administering the drug at two different times after the stress.
Methods
Healthy men (N=25) participated in two sessions; one with the Trier Social Stress Test, the other with a non-stressful control task, each followed by infusions of intravenous alcohol (targeting 40mg% in 5 min) and placebo. One group of participants received alcohol within 1 min of completing the tasks (Alc0, N=11), followed by placebo 30 min later. In the other group (Alc30, N=14), the order of alcohol and placebo infusions was reversed. Subjective effects (i.e., Anxiety, Stimulation, Want more) and physiological measures (heart rate, blood pressure, salivary cortisol) were measured before and at repeated intervals after the tasks and infusions.
Results
Stress did not change the subjective effects of alcohol in either group. However, when individual differences in alcohol responses were considered, stress differentially altered the stimulant-like and sedative effects of alcohol. Among individuals who exhibited predominantly stimulant responses to alcohol in the non-stressful condition, stress decreased the stimulant-like effects of alcohol and ‘wanting more’. By contrast, among participants who did not report stimulation after alcohol in the control session, stress decreased the sedative effects and increased ‘want more’. In addition, alcohol administered immediately after the TSST dampened cortisol responses yet prolonged negative subjective responses to the stress.
Conclusions
These findings demonstrate that there are bi-directional relationships between alcohol and stress. Alcohol influences responses to stress, and stress changes reactions to alcohol, depending on an individual's pattern of response to alcohol. This study highlights the fact that stress-alcohol interactions vary among individual drinkers, suggesting that the effects of stress on motivation to drink alcohol may also differ between individuals.
doi:10.1111/j.1530-0277.2011.01522.x
PMCID: PMC3183385  PMID: 21762177
Acute stress; Trier Social Stress Test; Alcohol; Anxiety; Cortisol
11.  Effects of Alcohol on Psychomotor Performance and Perceived Impairment in Heavy Binge Social Drinkers 
Drug and alcohol dependence  2007;91(1):10-17.
Alcohol intoxication often results in negative consequences; however, specific behavioral and subjective effects often vary as a function of individual differences. The present study utilized an alcohol challenge paradigm to examine whether heavy binge social drinkers (HD; n=77), compared to light social drinkers (LD; n=55), exhibit: 1) greater tolerance in psychomotor task performance under the influence of alcohol, and 2) differential perceptions of the impairing effects of alcohol. The study included three test sessions in which participants consumed either a low (0.4 g/kg) or a high (0.8 g/kg) dose of ethanol or a placebo beverage administered in random order and counterbalanced within group. Participants completed the Digit Symbol Substitution Task (DSST) and the Grooved Pegboard at pre-drink baseline and at multiple time points after beverage consumption. They also completed a scale of perceived impairment at several intervals after beverage consumption. Ethanol impaired performance at the high dose, but not at the low dose (ps < .001). The groups exhibited similar alcohol-induced impairment. However, HD reported lower self-perceived impairment compared to LD, particularly during the early portion of the blood alcohol curve (p < .001) when actual impairment was most pronounced. Thus, this study extends prior research in that habitual binge social drinking does not appear to be associated with tolerance to alcohol's impairing effects on select psychomotor skills. Further, results may have implications for alcohol-related harm as binge social drinkers regularly consume intoxicating doses of alcohol but may not be aware of the physical and cognitive impairments produced by alcohol.
doi:10.1016/j.drugalcdep.2007.04.013
PMCID: PMC2764986  PMID: 17560739
alcohol; binge social drinkers; psychomotor; DSST; Pegboard; perceived impairment
12.  Dissociable Effects of Kappa-Opioid Receptor Activation on Impulsive Phenotypes in Wistar Rats 
Neuropsychopharmacology  2013;38(11):2278-2285.
The kappa-opioid receptor (KOR) is the primary target for the endogenous opioid peptide dynorphin (DYN), and KORs reside within brain circuitry underlying the complex integration of information related to different behavioral domains such as motivation, negative affect, and decision-making. Alterations in extended amygdala DYNs and KOR function following chronic alcohol exposure have been shown to mediate escalated alcohol self-administration during acute withdrawal. In addition to excessive alcohol consumption and increased negative affect, other symptoms of alcohol dependence include compromised impulse control. Given that DYN and KOR expressions are dysregulated within prefrontal brain circuitry associated with decision-making and impulse control in alcohol-dependent humans and rodents, and have been shown to modify multiple neurotransmitter systems associated with impulse-control disorders, we hypothesized that KOR activation could contribute to impulsive phenotypes. To test this hypothesis, separate cohorts of male Wistar rats were trained in one of the two animal models of impulsivity: delay-discounting (DD) or stop-signal reaction time (SSRT) tasks, and once stable responding was observed, received intracerebroventricular (ICV) infusions of the KOR agonist U50,488 (0–50 μg) according to a within-subject dosing regimen. The results demonstrated a dissociable effect of U50,488 on impulsive phenotypes related to intolerance to delay or response inhibition, with selective effects in the SSRT. Furthermore, the pro-impulsive effects of KOR activation were rescued by pretreatment with the KOR antagonist nor-binaltorphimine (nor-BNI). Therefore, KOR activation was shown to induce an impulsive phenotype that was nor-BNI-sensitive. Dysregulation of impulsive behavior by increased DYN/KOR activity could serve to increase vulnerability for the initiation, or perpetuate existing patterns of excessive alcohol abuse and can enhance the probability of relapse in dependent individuals. Furthermore, KOR-mediated impulsivity has implications for numerous neuropsychiatric disorders.
doi:10.1038/npp.2013.129
PMCID: PMC3773679  PMID: 23689673
alcohol & alcoholism; delay-discounting; dynorphin; impulsivity; kappa-opioid receptor; mood/anxiety/stress disorders; neuropharmacology; opioids; stop-signal reaction time task; alcohol; dependence; delay-discounting; impulsivity; kappa-opioid receptor; stop-signal reaction time task
13.  Effects of energy drinks mixed with alcohol on information processing, motor coordination and subjective reports of intoxication 
The consumption of alcohol mixed with energy drinks (AmED) has become a popular and controversial practice among young people. Increased rates of impaired driving and injuries have been associated with AmED consumption. The purpose of this study was to examine if the consumption of AmED alters cognitive processing and subjective measures of intoxication compared with the consumption of alcohol alone. Eighteen participants (9 men and 9 women) attended 4 test sessions where they received one of 4 doses in random order (0.65 g/kg alcohol, 3.57 ml/kg energy drink, AmED, or a placebo beverage). Performance on a psychological refractory period (PRP) task was used to measure dual-task information processing and performance on the Purdue pegboard task was used to measure simple and complex motor coordination following dose administration. In addition, various subjective measures of stimulation, sedation, impairment, and level of intoxication were recorded. The results indicated that alcohol slowed dual-task information processing and impaired simple and complex motor coordination. The co-administration of the energy drink with alcohol did not alter the alcohol-induced impairment on these objective measures. For subjective effects, alcohol increases various ratings indicative of feelings of intoxication. More importantly, co-administration of the energy drink with alcohol reduced perceptions of mental fatigue and enhanced feelings of stimulation compared to alcohol alone. In conclusion, AmED may contribute to a high-risk scenario for a drinker. The mix of behavioral impairment with reduced fatigue and enhanced stimulation may lead AmED consumers to erroneously perceive themselves better able to function than is actually the case.
doi:10.1037/a0026136
PMCID: PMC3288788  PMID: 22023670
alcohol; energy drink; dual-task interference; mental fatigue; stimulation
14.  Impulsivity and alcohol consumption in young social drinkers 
Addictive behaviors  2011;37(2):217-220.
Impulsivity may have different facets that contribute to drinking patterns in young people. This research examined how aspects of impulse control, especially the ability to inhibit a response, predicted recent alcohol use patterns in young social drinkers. Participants (N = 109) between the ages of 18 and 21 performed a cued go/no-go task that required quick responses to go targets and the inhibition of responses to no-go targets. Participants also completed several questionnaires that assessed drinking habits (TLFB) and self-reported impulsivity (BIS-11). Regression analyses revealed that both the impulsivity questionnaire scores and the inhibitory failures observed on the behavioral task predicted various aspects of recent drinking. However, only the inhibitory failures from the behavioral task, and not the impulsivity questionnaire scores, predicted the highest number of drinks consumed on one occasion during the past month. These findings are consistent with the notion that impulsivity may have different components that may be contributing the drinking patterns, and this research suggests that the inability to withhold a response is a strong predictor of the binge use of alcohol.
doi:10.1016/j.addbeh.2011.09.013
PMCID: PMC3230724  PMID: 21981824
alcohol; binge drinking; impulsivity; behavioral control; reaction time
15.  Investigating the behavioral and self-report constructs of impulsivity domains using principal component analysis 
Behavioural Pharmacology  2009;20(5-6):390-399.
Impulsivity, often defined as a human behavior characterized by the inclination of an individual to act on urge rather than thought, with diminished regard to consequences, encompasses a range of maladaptive behaviors which are in turn affected by distinct neural systems. Congruent with the above definition, behavioral studies have consistently shown that the underlying construct of impulsivity is multidimensional in nature. However, research to date has been inconclusive regarding the different domains or constructs that constitute this behavior. In addition there is also no clear consensus as to whether self-report and laboratory based measures of impulsivity measure the same or different domains. The current study aimed to: 1) characterize the underlying multidimensional construct of impulsivity using a sample with varying degrees of putative impulsivity related to substance misuse, including subjects who were at-risk of substance use or addicted (ARA), and 2) assess relationships between self-report and laboratory measures of impulsivity, using a principal component-based factor analysis. In addition, our supplementary goal was to evaluate the structural constructs of impulsivity within each group separately (healthy and ARA). We used five self-report measures (Behavioral Inhibition System/Behavioral Activation System (BIS/BAS), Barratt Impulsivity Scale-11, Padua Inventory, Zuckerman Sensation Seeking Scale (SSS), and Sensitivity to Punishment and Sensitivity to Reward Questionnaire) and two computer based laboratory tasks (Balloon Analog Risk Task and the Experiential Delay Task) to measure aspects of impulsivity in a total of 176 adult subjects. Subjects included healthy controls (N=89), non-alcoholic subjects with family histories of alcoholism (FHP; N=36) and both former (N=20) and current (N=31) cocaine users. Subjects with a family history of alcoholism and cocaine abusers were grouped together as “at-risk/addicted” (ARA) to evaluate our supplementary goal. Our overall results revealed the multidimensional nature of the impulsivity construct as captured optimally through a five factor solution that accounted for nearly 70% of the total variance. The five factors/components were imputed as follows “Self-Reported Behavioral Activation”, “Self-Reported Compulsivity and Reward/Punishment”, “Self-Reported Impulsivity”, “Behavioral Temporal Discounting” and “Behavioral Risk-Taking.” We also found that contrary to previously published reports, there was significant overlap between certain laboratory and self-report measures, indicating that they might be measuring the same impulsivity domain. In addition, our supplemental analysis also suggested that the impulsivity constructs were largely, but not entirely the same within the healthy and ARA groups.
doi:10.1097/FBP.0b013e32833113a3
PMCID: PMC3268653  PMID: 19724194
impulsivity; behavior; substance abuse; cocaine; alcohol; factor analysis; PCA; BIS-BAS; BIS-11; EDT; BART; Zuckerman; SPSRQ; human
16.  The Alternative Substance Paradigm:Effectiveness of Beverage Blinding and Effects on Acute Alcohol Responses 
A fundamental goal of double-blind alcohol challenge studies is to reduce alcohol expectancies, though there is little research on the effectiveness of blinding procedures and their relationship to acute alcohol responses. This study examined social drinkers’ perception of beverage content and related alcohol response during three separate double-blind experimental sessions with placebo, low dose alcohol (0.4 g/kg), and high dose alcohol (0.8 g/kg). Using the Alternative Substance Paradigm, participants (N=182) were informed that the beverage they consumed might contain alcohol, a stimulant, a sedative, or a placebo. At several timepoints, subjective and objective measures were obtained and participants were asked to identify which substance they received. During both placebo and low dose alcohol sessions, 33% and 50% of participants, respectively, did not correctly identify the beverage content; during the high dose alcohol session, 20% did not correctly identify the beverage. While correct and incorrect identifiers at any dose level did not differ on major background variables, drinking characteristics, or psychomotor performance during these sessions, they did differ on self-reported subjective responses, with greater sedation reported by incorrect identifiers in the placebo and high dose conditions. In sum, results suggest that the Alternative Substance Paradigm may be a viable option for alcohol laboratory studies, particularly for repeated sessions in within-subjects designs and in cases where the experimenter wants to reduce expectancy by not revealing a priori that alcohol is being administered.
doi:10.1037/a0029261
PMCID: PMC4048031  PMID: 22867037
alcohol; social drinker; blinding procedures; alcohol expectancy; balanced-placebo design; alternative substance paradigm
17.  Acute Tolerance to Alcohol in At-risk Binge Drinkers 
Studies of the impairing effects of alcohol on behavior often show greater tolerance in heavy drinkers compared to light drinkers, suggesting a causal link between heavy consumption and tolerance. Tolerance also develops during the time-course of a single drinking episode, and this “acute tolerance” might play an important role in the escalation to heavy drinking. The present study examined the development of acute tolerance to the impairing effects of alcohol on motor coordination and inhibitory control in a group of at-risk, binge drinkers (N = 20) and a group of non-risk, moderate drinkers (N = 20). Participants performed the testing battery in response to placebo and a moderate dose of alcohol (0.65 g/kg) twice at comparable blood alcohol concentrations (BACs): once on the ascending limb and once on the descending limb of the blood alcohol curve. Results showed marked acute tolerance to the impairing effects of alcohol on motor coordination in the at-risk drinkers. By contrast, no recovery of motor skill was observed in the non-risk drinkers. Regarding inhibitory control, both groups remained impaired on both the ascending and descending limbs, indicating no acute tolerance in either group. The findings suggest that at-risk, binge drinkers display a faster recovery in their ability to execute versus inhibit action under alcohol. Such an “activational bias” of behavior could account for their continued alcohol consumption and impulsive behaviors while intoxicated, especially as BAC begins to decline.
doi:10.1037/a0026110
PMCID: PMC3326440  PMID: 22023021
Alcohol; acute tolerance; binge; inhibitory control; motor coordination
18.  A Test of Alcohol Dose Effects on Multiple Behavioral Measures of Impulsivity 
Drug and alcohol dependence  2008;96(1-2):111-120.
Background
Acute alcohol administration affects impulsive behavior, although these effects vary as a function of alcohol dose, assessment instrument, and time of measurement following administration.
Methods
We concurrently examined the dose-dependent effects of alcohol on three distinct types of impulsivity tasks (continuous performance [IMT], stop-signal [GoStop], and delay-discounting [SKIP] tasks). Ninety healthy alcohol drinkers were assigned to one of the three task groups (n = 30 each), each group experienced placebo, 0.2, 0.4, 0.6, and 0.8 g/kg alcohol doses across 5 experimental days, and task performance was assessed at 0.5 h before and 0.25, 1.0, and 2.0 h after alcohol administration. We hypothesized that impulsive responding on all tasks would be increased by acute alcohol administration both across time and during the peak BrAC, but the magnitude would depend on the task being tested. Analyses included the time-course and the peak BrAC effects. Task comparisons of peak behavioral changes following each dose are illustrated using standardized scores.
Results
While alcohol consumption increased impulsive responding during all three tasks to some extent, our hypothesis was only partially supported. During the IMT, the 0.6 and 0.8 g/kg doses produced increased impulsive responding across time and at the peak BrAC. However, during the GoStop and SKIP, impulsivity increased across time regardless of the alcohol dose size, with no differences in impulsive responding among dose conditions at peak BrAC.
Conclusions
This study demonstrated alcohol-induced changes in impulsivity are not uniformly affected by alcohol. These data, in conjunction with previous studies, further support that impulsivity is not a unitary construct.
doi:10.1016/j.drugalcdep.2008.02.002
PMCID: PMC2566966  PMID: 18378098
Alcohol; Doses; Impulsivity; Behavior; Task Comparison; Human; Adults
19.  Subjective perceptions associated with the ascending and descending slopes of breath alcohol exposure vary with recent drinking history 
Background
The Differentiator Model predicts that individuals with a positive family history of alcoholism or heavy alcohol consumers will feel more sensitive to the effects of alcohol on the ascending phase of the blood alcohol content while feeling less sedated on the descending phase. This study tested if subjective perceptions are sensitive to the slope of breath alcohol concentration and if that sensitivity is associated with a family history of alcoholism (FHA) and/or recent drinking history (RDH).
Methods
Family history positive (FHP, N=27) and family history negative (FHN, N=27) young adult non-dependent drinkers were infused intravenously with alcohol in 2 sessions separated by one week. After 20 minutes, one session had an ascending BrAC (+3.0mg% per min) while the other session had a descending BrAC (−1 mg% per min). The BrAC for both sessions at this point was approximately 60 mg%, referred to as the crossover point. Subjective perceptions of intoxication, high, stimulated, and sedation were sampled frequently, then interpolated to the crossover point. Within-subject differences between ascending and descending responses were examined for associations with FHA and/or RDH.
Results
Recent moderate drinkers reported increased perceptions of feeling intoxicated (p<0.023) and high (p<0.023) on the ascending slope compared to the descending slope. In contrast, recent light drinkers felt more intoxicated and high on the descending slope.
Conclusion
Subjective perceptions in young adult social drinkers depend on the slope of the BrAC when examined in association with RDH. These results support the Differentiator Model hypothesis concerning the ascending slope and suggest that moderate alcohol consumers could be at risk for increased alcohol consumption because they feel more intoxicated and high on the ascending slope. Subjects did not feel less sedated on the descending slope, contrary to the Differentiator Model but replicating several previous studies.
doi:10.1111/j.1530-0277.2011.01642.x
PMCID: PMC3288407  PMID: 21933199
subjective perceptions; slope of brain exposure to alcohol; family history of alcoholism (FHA); recent drinking history (RDH)
20.  Acute Alcohol Intoxication Impairs Top-down Regulation of Stroop Incongruity as Revealed by BOLD fMRI 
Human brain mapping  2011;33(2):319-333.
Functional neuroanatomy of executive functions has been delineated in a large number of neuroimaging studies using conflict-inducing tasks. The neural basis of alcohol’s effects on cognitive control is poorly understood despite the evidence of impaired ability to evaluate competing demands and to inhibit maladaptive responses. In order to investigate effects of moderate intoxication, healthy social drinkers participated in both alcohol (0.60 g/kg ethanol for men, 0.55 g/kg for women) and placebo conditions while being scanned using blood oxygen level dependent (BOLD) fMRI. A modified 4-color Stroop task combined reading and color naming and used manual responses. Twenty subjects (10 women) were instructed to press a button corresponding to the font color except when a word was written in gray in which case they had to respond to the meaning of the word. Alcohol increased reaction times and a tendency to make more errors on incongruent trials. Behavioral indices of alcohol-induced premature responding correlated with the current drinking levels and impulsivity traits, suggesting an interaction between alcohol effects and personality predispositions. A distributed fronto-parietal cortical network was activated by incongruity. However, moderate alcohol inebriation selectively attenuated anterior cingulate cortex (ACC) activation during both high-conflict trials and erroneous responses, indicating vulnerability of the regulative function subserved by the ACC. By disrupting top-down, strategic processing, alcohol may interfere with goal-directed behavior, resulting in poor self control. The present results support models proposing that alcohol-induced prefrontal impairments diminish inhibitory control and are modulated by dispositional risk factors and levels of alcohol consumption.
doi:10.1002/hbm.21213
PMCID: PMC3754428  PMID: 21391268
cognitive control; anterior cingulate; error-related activity
21.  Psychophysiological Responses to Stress Following Alcohol Intake in Social Drinkers Who Are at Risk of Hazardous Drinking 
Biological psychology  2013;93(1):9-16.
We examined whether social drinkers whose drinking behavior poses a risk for harmful consequences exhibit altered psychobiological responses to stress following moderate alcohol intake. At risk (n = 17) and low risk drinkers (n = 27), as identified by the Alcohol Use Disorders Identification Test, completed two laboratory stress sessions, one in which they consumed a drink with alcohol and one without alcohol. Subjective and physiological measures were obtained throughout the study. Reported stimulation following alcohol consumption and sedation post-stress on alcohol day were greater than the no alcohol day in at risk drinkers (ps < .05). Low risk drinkers exhibited stress dampening effects on cortisol levels (p < .05). This was not the case among the high risk drinkers. These results indicate that acute alcohol intake may be associated with enhanced subjective and altered hormonal responses to stress in individuals who are at risk for becoming problem drinkers.
doi:10.1016/j.biopsycho.2012.12.009
PMCID: PMC3622864  PMID: 23313460
alcohol; cortisol; stress; AUDIT; substance use
22.  The Effectiveness of Community Action in Reducing Risky Alcohol Consumption and Harm: A Cluster Randomised Controlled Trial 
PLoS Medicine  2014;11(3):e1001617.
In a cluster randomized controlled trial, Anthony Shakeshaft and colleagues measure the effectiveness of a multi-component community-based intervention for reducing alcohol-related harm.
Background
The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data.
Methods and Findings
We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000–20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department–based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001–2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = −3.37 to −0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates.
Conclusions
This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12607000123448
Please see later in the article for the Editors' Summary
Editors' Summary
Background
People have consumed alcoholic beverages throughout history, but alcohol use is now an increasing global public health problem. According to the World Health Organization's 2010 Global Burden of Disease Study, alcohol use is the fifth leading risk factor (after high blood pressure and smoking) for disease and is responsible for 3.9% of the global disease burden. Alcohol use contributes to heart disease, liver disease, depression, some cancers, and many other health conditions. Alcohol also affects the well-being and health of people around those who drink, through alcohol-related crimes and road traffic crashes. The impact of alcohol use on disease and injury depends on the amount of alcohol consumed and the pattern of drinking. Most guidelines define long-term risky drinking as more than four drinks per day on average for men or more than two drinks per day for women (a “drink” is, roughly speaking, a can of beer or a small glass of wine), and short-term risky drinking (also called binge drinking) as seven or more drinks on a single occasion for men or five or more drinks on a single occasion for women. However, recent changes to the Australian guidelines acknowledge that a lower level of alcohol consumption is considered risky (with lifetime risky drinking defined as more than two drinks a day and binge drinking defined as more than four drinks on one occasion).
Why Was This Study Done?
In 2010, the World Health Assembly endorsed a global strategy to reduce the harmful use of alcohol. This strategy emphasizes the importance of community action–a process in which a community defines its own needs and determines the actions that are required to meet these needs. Although community action is highly acceptable to community members, few studies have looked at the effectiveness of community action in reducing risky alcohol consumption and alcohol-related harm. Here, the researchers undertake a cluster randomized controlled trial (the Alcohol Action in Rural Communities [AARC] project) to quantify the effectiveness of community action in reducing risky alcohol consumption and harms in rural communities in Australia. A cluster randomized trial compares outcomes in clusters of people (here, communities) who receive alternative interventions assigned through the play of chance.
What Did the Researchers Do and Find?
The researchers pair-matched 20 rural Australian communities according to the proportion of their population that was Aboriginal (rates of alcohol-related harm are disproportionately higher among Aboriginal individuals than among non-Aboriginal individuals in Australia; they are also higher among young people and males, but the proportions of these two groups across communities was comparable). They randomly assigned one member of each pair to the experimental group and implemented 13 interventions in these communities by negotiating with key individuals in each community to define and implement each intervention. Examples of interventions included general practitioner training in screening for alcohol use disorders and in implementing a brief intervention, and a school-based interactive session designed to reduce alcohol harm among young people. The researchers quantified the effectiveness of the interventions using routinely collected data on alcohol-related crime and road traffic crashes, and on hospital inpatient admissions for alcohol dependence or abuse (which were expected to increase in the experimental group if the intervention was effective because of more people seeking or being referred for treatment). They also examined drinking habits and experiences of alcohol-related harm, such as verbal abuse, among community members using pre- and post-intervention surveys. After implementation of the interventions, the rates of alcohol-related crime, road traffic crashes, and hospital admissions, and of risky and hazardous/harmful alcohol consumption (measured using a validated tool called the Alcohol Use Disorders Identification Test) were not statistically significantly different in the experimental and control communities (a difference in outcomes that is not statistically significantly different can occur by chance). However, the reported average weekly consumption of alcohol was 20% lower in the experimental communities after the intervention than in the control communities (equivalent to 1.9 fewer standard drinks per week per respondent) and there was less alcohol-related verbal abuse post-intervention in the experimental communities than in the control communities.
What Do These Findings Mean?
These findings provide little evidence that community action reduced risky alcohol consumption and alcohol-related harms in rural Australian communities. Although there was some evidence of significant reductions in self-reported weekly alcohol consumption and in experiences of alcohol-related verbal abuse, these findings must be interpreted cautiously because they are based on surveys with very low response rates. A larger or differently designed study might provide statistically significant evidence for the effectiveness of community action in reducing risky alcohol consumption. However, given their findings, the researchers suggest that legislative approaches that are beyond the control of individual communities, such as alcohol taxation and restrictions on alcohol availability, may be required to effectively reduce alcohol harms. In other words, community action alone may not be the most effective way to reduce alcohol-related harm.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001617.
The World Health Organization provides detailed information about alcohol; its fact sheet on alcohol includes information about the global strategy to reduce the harmful use of alcohol; the Global Information System on Alcohol and Health provides further information about alcohol, including information on control policies around the world
The US National Institute on Alcohol Abuse and Alcoholism has information about alcohol and its effects on health
The US Centers for Disease Control and Prevention has a website on alcohol and public health that includes information on the health risks of excessive drinking
The UK National Health Service Choices website provides detailed information about drinking and alcohol, including information on the risks of drinking too much, tools for calculating alcohol consumption, and personal stories about alcohol use problems
MedlinePlus provides links to many other resources on alcohol
More information about the Alcohol Action in Rural Communities project is available
doi:10.1371/journal.pmed.1001617
PMCID: PMC3949675  PMID: 24618831
23.  Acute disinhibiting effects of alcohol as a factor in risky driving behavior 
Drug and alcohol dependence  2008;95(1-2):97-106.
Automobile crash reports show that up to 40% of fatal crashes in the United States involve alcohol and that younger drivers are over-represented. Alcohol use among young drivers is associated with impulsive and risky driving behaviors, such as speeding, which could contribute to their over-representation in alcohol-related crash statistics. Recent laboratory studies show that alcohol increases impulsive behaviors by impairing the drinker’s ability to inhibit inappropriate actions and that this effect can be exacerbated in conflict situations where the expression and inhibition of behavior are equally motivating. The present study tested the hypothesis that this response conflict might also intensify the disruptive effects of alcohol on driving performance. Fourteen subjects performed a simulated driving and a cued go/no-go task that measured their inhibitory control. Conflict was motivated in these tasks by providing equal monetary incentives for slow, careful behavior (e.g., slow driving, inhibiting impulses) and for quick, abrupt behavior (fast driving, disinhibition). Subjects were tested under two alcohol doses (0.65 g/kg and a placebo) that were administered twice: when conflict was present and when conflict was absent. Alcohol interacted with conflict to impair inhibitory control and to increase risky and impaired driving behavior on the drive task. Also, individuals whose inhibitory control was most impaired by alcohol displayed the poorest driving performance under the drug. The study demonstrates potentially serious disruptions to driving performance as a function of alcohol intoxication and response conflict, and points to inhibitory control as an important underlying mechanism.
doi:10.1016/j.drugalcdep.2007.12.018
PMCID: PMC2376256  PMID: 18325693
Alcohol; Driving; Impulsivity; Response Conflict
24.  Acute Interaction of Baclofen in Combination with Alcohol in Heavy Social Drinkers 
Background
There is growing evidence that GABA-B receptor agonists may be effective in the treatment of alcohol abuse or dependence. The primary goal of this study was to determine the safety of baclofen in combination with alcohol consumption in heavy drinkers. In addition, the effects of baclofen alone, and in combination with alcohol, on subjective effects, cognitive performance effects, as well as alcohol craving, were assessed.
Methods
Eighteen non-treatment seeking heavy social drinkers (mean of 28 drinks/week) who did not meet criteria for alcohol dependence participated. All individuals were tested using a double-blind double-dummy design with six 2-day inpatient phases. Baclofen (0, 40, and 80 mg) was administered 2.5 hours before alcohol (1.5 g/l body water or approximately 0.75 g/kg) or placebo beverages, given in 4 divided doses every 20 min.
Results
Baclofen, either alone, or in combination with alcohol, produced only modest increases in heart rate and blood pressure and no adverse effects were reported. Baclofen did not increase positive subjective effects (e.g., Stimulant effects, Drug Liking) but did increase sedation and impair performance. Even though both baclofen and alcohol impaired performance, for the most part performance was not impaired to a greater extent when baclofen was combined with alcohol. Among this population of non-dependent drinkers, baclofen did not alter alcohol craving or alcohol-induced positive subjective effects.
Conclusions
Baclofen alone has minimal abuse liability in heavy social drinkers and baclofen is relatively well tolerated and safe when given in combination with intoxicating doses of alcohol.
doi:10.1111/j.1530-0277.2008.00805.x
PMCID: PMC2626149  PMID: 18840257
Baclofen; GABA; Alcohol; Medication development; Heavy Social Drinkers
25.  The role of impulsivity and perceived availability on cue-elicited craving for alcohol in social drinkers 
Psychopharmacology  2012;224(1):145-153.
Rationale
Previous research has demonstrated a role for impulsivity and perceived availability of the substance in cue-elicited craving. However, their effects on cue-elicited craving for alcohol are still ambiguous. Most important is that there has been no empirical evidence for the potential interaction of these factors on alcohol craving.
Objectives
The aim of the present study was to examine the effects of response inhibition and perceived availability on cue-elicited craving for alcohol in social drinkers.
Methods
Participants were light to moderate social drinkers (N = 75) who were exposed to neutral- and alcohol-related stimuli during a single laboratory session. Response inhibition was assessed with the Stop Signal Task. Participants were randomly assigned to one of two perceived availability groups (n = 37, expecting alcohol; n = 38, not expecting alcohol).
Results
Overall craving for alcohol was higher in participants who expected alcohol than in those who did not. This finding was statistically significant only in the alcohol condition. Most important is that there was a significant interaction between response inhibition, perceived availability and time on cue-elicited craving. Regardless of the cue type, impulsive people who expected alcohol experience a significant increase in cue-elicited craving relative to impulsive people who did not expect alcohol. This effect was not observed in the non-impulsive groups.
Conclusions
The results clearly show that perceived availability alone and in combination with response inhibition can modulate alcohol cue reactivity. Theoretical explanations and clinical implications of these findings are discussed.
doi:10.1007/s00213-012-2747-4
PMCID: PMC3465646  PMID: 22638812
Cue reactivity; Craving; Alcohol cue exposure; Impulsivity; Response inhibition; Perceived availability

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