To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand.
A randomized controlled trial was conducted in eight PCUs in Ubonratchatanee and Chachoengsao provinces in Thailand. Hazardous drinkers were identified using the World Health Organization-recommended Alcohol Use Disorder Identification Test. Of 117 eligible participants (91% male), 59 were randomized to the intervention group to receive MET in three individual appointments with a trained nurse and 58 to an assessment-only control group. Outcome evaluations were carried out after 6 weeks, 3 months and 6 months.
Follow-up data were available on 84, 94 and 91% of subjects, respectively, at the three intervals. Self-reported drinks per drinking day, frequency of hazardous drinking assessed either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention group more than in the control group (P < 0.05) after both 3 and 6 months. The groups did not generally differ at 6 weeks. However, although self-reported consumption in both groups fell from baseline to 6-month follow-up, serum gamma-glutamyl transferase increased in both groups, which raises doubts about the validity of this marker in this sample and/or the validity of the self-reported data in this study.
MET delivered by nurses in PCUs in Thailand appears to be an effective intervention for male hazardous drinkers. Uncertainties about the validity of self-reported data jeopardize the safety of this conclusion.
This paper describes adolescents’ exposure to alcohol advertising in stores and to alcohol-branded promotional items and their association with self-reported drinking.
A cross-sectional survey was administered in non-tracked required courses to sixth, seventh, and eighth graders (n = 2125) in three California middle schools. Logistic regressions compared the odds of ever (vs. never) drinking and current (vs. ever) drinking after controlling for psychosocial and other risk factors for adolescent alcohol use.
Two-thirds of middle school students reported at least weekly visits to liquor, convenience, or small grocery stores where alcohol advertising is widespread. Such exposure was associated with higher odds of ever drinking, but was not associated with current drinking. One-fifth of students reported owning at least one alcohol promotional item. These students were three times more likely to have ever tried drinking and 1.5 times more likely to report current drinking than students without such items.
This study provides clear evidence of an association of adolescent drinking with weekly exposure to alcohol advertising in stores and with ownership of alcohol promotional items. Given their potential influence on adolescent drinking behaviour, retail ads, and promotional items for alcohol deserve further study.
Concurrent measures of event-related potentials (ERPs) and skin conductance responses were obtained in an auditory oddball task consisting of rare target, rare non-signal unique novel and frequent standard tones. Twelve right-handed male social drinkers participated in all four cells of the balanced placebo design in which effects of beverage and instructions as to the beverage content (expectancy) were independently manipulated. The beverage contained either juice only, or vodka mixed with juice in the ratio that successfully disguised the taste of alcohol and raised average peak blood alcohol level to 0.045%. ERPs were sensitive to adverse effects of mild inebriation, whereas behavioral measures were not affected. Alcohol ingestion reliably increased N2 amplitude and reduced the Late Positive Complex (LPC). A large, fronto-central P3a (280 ms latency) was recorded to novel sounds in placebo condition, but only on the trials that also evoked electrodermal orienting responses. Both novel and target stimuli evoked a posterior P3b (340 ms) which was independent of orienting. Alcohol selectively attenuated the P3a to novel sounds on trials with autonomic arousal. This evidence confirms the previously suggested distinction between the subcomponents of the LPC: P3a may be a central index of orienting to novel, task-irrelevant but potentially significant stimuli and is an important component of the arousal system. P3b does not have a clear relationship with arousal and may embody voluntary cognitive processing of rare task-related stimuli. Overall, these results indicate that alcohol affects multiple brain systems concerned with arousal, attentional processes and cognitive-autonomic integration.
alcohol; auditory oddball; arousal; P3a; skin conductance; novelty
For well over a decade, the Important People Inventory (IP, Clifford and Longabaugh, 1991; Clifford et al., 1992) has been used to collect a wide range of valuable information regarding network support for alcohol use. However, because of psychometric limitations and varied adaptations of the IP, the following study performed factor analyses to develop a more structurally consistent model of the scale as compared to the existing model.
A first principal components analysis (Varimax rotation) was run on the indices of the IP using data from a national investigation of residents within a recovery community (N = 897). Next, a second principal components analysis was run using data collected from participants recruited from inpatient treatment settings (N = 150).
Results indicated a nine-index, three-factor model, which explained about two thirds of the common variance. These three factors included: Support for Drinking from Network Members (3 items), Drinking Behaviours of Network Members (3 items), and General Social Support (3 items).
Results of both studies suggest that the IP fits a multi-component structure. It is recommended that Drinking Behaviours of Network Members be examined for predictive validity and that General Social Support be removed from the scale or have additional items added.
Excess activation of glutamatergic neurotransmission in the cerebral cortex following ethanol withdrawal is considered to contribute to significant behavioural disturbances, and to alcohol craving. Astrocytes may play a role in these manifestations because astrocytes are essential in the regulation of released glutamate and its conversion to glutamine through the enzyme glutamine synthetase (GS). However, it is unclear if withdrawal from free-choice ethanol drinking causes changes in the numbers of astrocytes expressing GS or the cytoskeletal protein of astrocytes glial fibrillary acidic protein (GFAP). Alcohol-preferring (P) rats exposed to free-choice ethanol drinking were either maintained without forced interruption of ethanol drinking, subjected to a 3-day withdrawal period at the end of 2 months, or subjected to three 3-day withdrawal periods along 6 months. At 2 months, P rats were also compared with alcohol-naïve alcohol non-preferring rats (NP) rats. Packing density of GS and GFAP-immunoreactive (IR) astrocytes was measured in sections from the prelimbic cortex (PLC) using the optical disector probe. An alcohol deprivation effect was observed in P rats with withdrawals during a 6-month ethanol drinking period. Ethanol withdrawal significantly increased the packing density of GS- and GFAP-IR astrocytes in the PLC of P rats as compared with P rats with continuous access to ethanol. In addition, there was a positive correlation between the pre-withdrawal ethanol consumption and the packing density of GS-IR astrocytes. The present results suggest the involvement of astrocytes in the regulation of the glutamatergic activation associated with withdrawal from free-choice ethanol consumption and point to differential adaptations of GS and GFAP to prolonged alcohol drinking in the PLC of P rats.
Aims: The aim of this study was to investigate longitudinal changes in quality of life (QOL) as a function of transitions in alcohol use disorders (AUD) over a 3-year follow-up of a general US population sample. Methods: The analysis is based on individuals who drank alcohol in the year preceding the Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions and were reinterviewed at Wave 2 (n = 22,245). Using multiple linear regression models, changes in SF-12 QOL were estimated as a function of DSM-IV AUD transitions, controlling for baseline QOL and multiple potential confounders. Results: Onset and offset of AUD were strongly associated with changes in mental/psychological functioning, with significant decreases in mental component summary (NBMCS) scores among individuals who developed dependence and significant increases among those who achieved full and partial remission from dependence. The increases in overall NBMCS and its social functioning, role emotional and mental health components were equally great for abstinent and nonabstinent remission from dependence, but improvements in bodily pain and general health were associated with nonabstinent remission only. Onset of abuse was unrelated to changes in QOL, and the increase in NBMCS associated with nonabstinent remission from abuse only was slight. Individuals with abuse only or no AUD who stopped drinking had significant declines in QOL. Conclusions: These results suggest the possible importance of preventing and treating AUD for maintaining and/or improving QOL. They are also consistent with the sick quitter hypothesis and suggest that abuse is less a mental disorder than a maladaptive pattern of behavior.
The aim of this study was to demonstrate a methodology for estimating detailed energy intake from alcoholic beverages.
Participants were 315 monthly drinkers who completed a drink-measuring exercise. Energy intake from alcohol and non-alcohol ingredients was calculated for all beverages consumed.
Measured alcoholic beverages had on average 140 kilocalories, with 26% of the energy coming from non-alcohol ingredients. The average monthly kilocalorie intake, from all alcoholic beverage types, was 6423 kilocalories. Self-measured wine and spirits drinks contained more energy than reference standards for size and ethanol concentration.
Amount and sources of kilocalories differ by drink type, gender, age, education and BMI. Researchers and consumers should be aware of this variation and its sources.
To investigate longitudinal changes in quality of life (QOL) as a function of transitions in alcohol use disorders (AUD) over a 3-year follow-up of a general U.S. population sample.
The analysis is based on individuals who drank alcohol in the year preceding the Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions and were reinterviewed at Wave 2 (n=22,245). Using multiple linear regression models, changes in SF-12 QOL were estimated as a function of DSM-IV AUD transitions, controlling for baseline QOL and multiple potential confounders.
Onset and offset of AUD were strongly associated with changes in mental/psychological functioning, with significant decreases in mental component summary (NBMCS) scores among individuals who developed dependence and significant increases among those who achieved full and partial remission from dependence. The increases in overall NBMCS and its social functioning, role emotional and mental health components were equally great for abstinent and nonabstinent remission from dependence, but improvements in bodily pain and general health were associated with nonabstinent remission only. Onset of abuse was unrelated to changes in QOL, and the increase in NBMCS associated with nonabstinent remission from abuse only was slight. Individuals with abuse only or no AUD who stopped drinking had significant declines in QOL.
These results suggest the possible importance of preventing and treating AUD for maintaining and/or improving QOL. They are also consistent with the sick quitter hypothesis and suggest that abuse is less a mental disorder than a maladaptive pattern of behavior.
quality of life; QOL; HRQOL; alcohol use disorders; remission; transitions
Aim: The aim of this study was to demonstrate a methodology for estimating detailed energy intake from alcoholic beverages. Methods: Participants were 315 monthly drinkers who completed a drink-measuring exercise. Energy intake from alcohol and non-alcohol ingredients was calculated for all beverages consumed. Results: Measured alcoholic beverages had on average 140 kilocalories, with 26% of the energy coming from non-alcohol ingredients. The average monthly kilocalorie intake, from all alcoholic beverage types, was 6423 kilocalories. Self-measured wine and spirits drinks contained more energy than reference standards for size and ethanol concentration. Conclusions: Amount and sources of kilocalories differ by drink type, gender, age, education and BMI. Researchers and consumers should be aware of this variation and its sources.
In vivo proton nuclear magnetic resonance (1H NMR) studies of ethanol in animal and human brains have shown that only a fraction of ethanol in brain is visible by NMR. The goals of these in vitro 1H NMR experiments were to determine: (1) whether the interaction of ethanol with brain membranes in vitro diminishes ethanol visibility; and (2) if a magnetization transfer (MT) effect can be observed for the interaction of ethanol with brain membranes in vitro. Furthermore, pilot studies were performed to determine if the brain membranes from rats chronically exposed to ethanol had a different effect on ethanol NMR visibility and spin–spin relaxation time (T2) than brain membranes obtained from control rats. Results show that the NMR visibility of ethanol is lower in rat brain membrane suspensions in vitro as compared to ethanol in saline solutions. The factors decreasing ethanol NMR visibility are T2 relaxation, water presaturation time, and off-resonance saturation by a frequency-dependent MT pulse. One-pulse NMR measurements without water presaturation showed that ethanol visibility was significantly increased by 15% in brain membrane suspensions of ethanol-fed rats, suggestive of decreased ethanol partitioning compared to controls. Furthermore ethanol in brain membrane suspensions from ethanol-fed rats showed smaller MT effects than from control rats. These results provide a mechanism for decreased NMR visibility of ethanol in brain, and suggest that chronic exposure to ethanol produces membrane changes which result in increased NMR visibility.
We conducted a review of published reports of smoking cessation pharmacotherapy trials in order to address the following: 1) the generalizability of findings to smokers with a history of alcohol problems; 2) the extent to which alcohol use affects smoking cessation overall and the efficacy of pharmacotherapy specifically and 3) the effect of smoking cessation on alcohol use.
We located published reports of nicotine replacement therapy (NRT), bupropion sustained release (SR) and varenicline clinical trials using an approach based on prior Cochrane reviews. The reports were searched for alcohol-related inclusion/exclusion criteria and for findings related to alcohol.
The present review included 212 published reports from 149 trials. Alcohol-related exclusion criteria appeared frequently (41.6% of trials)—45/125 NRT trials (36%), 15/22 bupropion SR trials (68.2%) and 3/3 varenicline trials—and most commonly involved exclusion of participants with either current or recent alcohol problems. Most studies failed to provide any baseline alcohol-related characteristics. Eleven trials reported on the relationship between alcohol history and likelihood of smoking cessation. In the majority of these studies, smokers with a past history of alcohol problems were not at a disadvantage, although contrary findings exist. Only two studies examined the potential influence of smoking cessation on alcohol use.
Smokers with alcohol problems, particularly those with current or recent problems, are underrepresented in studies of approved pharmacotherapy for smoking cessation. Future trials should assess alcohol use at baseline and during treatment and examine reciprocal influences between alcohol consumption and smoking cessation.
alcohol; bupropion SR; co-morbidity; nicotine replacement therapy; smoking cessation; varenicline
Individuals in treatment for alcohol use disorders are more likely to die from cigarette use than from alcohol consumption. Advanced statistical methodologies that increase study power and clinical relevance have been advocated to examine the timevarying nature of substance use relapse and abstinence, including drinking and smoking. The purpose of this investigation was to examine timevarying factors that are associated with smoking cessation among smokers in the general population, including alcohol use, self-efficacy, and depression, to determine if they were also related to smoking cessation during and after treatment for alcohol use disorders.
Data were garnered from Project MATCH, a longitudinal prospective study of the efficacy of three behavioural treatments for alcohol use disorders. Timevarying covariate analyses were conducted to examine future smoking cessation.
Results showed that greater self-efficacy regarding resisting temptations to drink and lower levels of depression were independently associated with increased likelihood of stopping smoking. In contrast, drinks per drinking day and confidence regarding not drinking did not demonstrate such associations.
Clinical implications of these findings suggest that interventions to help alcoholics in recovery avoid temptations to drink, as well as decrease depression, may be warranted. By using advanced statistical techniques, these results can help clinicians and organizations working with smokers in treatment for alcohol use disorders to make informed decisions regarding how best to use limited resources.
Impaired control, one of the hallmarks of addiction, is also one of the earliest dependence symptoms to develop. Thus impaired control is particularly relevant to undergraduates and other young adults with relatively brief drinking histories. The main goal of this study was to determine whether impaired control predicted heavy episodic drinking and alcohol-related problems cross-sectionally in an undergraduate sample after controlling for gender, family history of alcohol and drug problems and several other established predictor variables from the undergraduate alcohol literature.
A sample of first-year undergraduates (N = 312) completed Part 2 of the Impaired Control Scale (ICS; Heather et al., 1993) and other measures related to alcohol use as part of a larger study on problem drinking in undergraduates.
Scores on Part 2 of the ICS predicted heavy episodic drinking and alcohol-related problems cross-sectionally even after controlling for all other predictor variables. Notably, impaired control was a stronger predictor of alcohol-related problems than overall weekly alcohol consumption. Part 2 of the ICS was found to be a reliable and valid measure for use with undergraduates.
These findings support the notion that impaired control is one of the earliest dependence symptoms to develop. The ICS is an effective tool for identifying young adults at risk for problem drinking.
Impaired control; undergraduate drinking; alcohol-related problems; heavy episodic drinking
To determine how alcohol use differentially affects brain functioning in male and female adolescents.
Adolescents with alcohol use disorders (AUDs; 7 female, 11 male) and control adolescents without AUDs (9 female, 12 male), aged 14−17 years, performed spatial working memory and vigilance tasks during functional magnetic resonance imaging.
Gender, AUD and their interaction were significantly associated with brain activation patterns to the tasks. There were interactions in the superior frontal, superior temporal, cingulate and fusiform regions, in which female and male adolescents with AUDs showed a different brain response from each other and control subjects. Overall, female adolescents with AUDs showed a greater departure from normal activation patterns than male adolescents with AUD.
Adolescent alcohol involvement may affect male and female brains differently, and adolescent females may be somewhat more vulnerable to adverse alcohol effects. With continued drinking, these adolescents may be at an increased risk for behavioural deficits.
Little is known about how non-problematic drinkers respond to advice to reduce alcohol consumption as part of disease management. In this article, we examine patient reports of drinking behaviour after being diagnosed with chronic hepatitis C, a condition for which alcohol consumption is contraindicated.
In this qualitative study, we analyzed transcripts of semi-structured interviews with hepatitis C virus+ (HCV+) patients whose level of alcohol consumption would not be considered problematic in the absence of their diagnosis.
Most respondents reported some instances of adherence, but only half adhered to the advice to limit drinking consistently over time. Respondents who did not stop drinking often modified their behaviour by changing the type of alcohol consumed or limiting drinking to particular occasions.
Most informants understood the risks of drinking after HCV infection, particularly in the presence of symptoms, with the onset of complications, or when undergoing treatment. But some believed they could monitor their bodies for evidence of disease progression or that drinking was acceptable during early, asymptomatic stages of infection. Our results also identified situations in which patients need support in adhering to intentions not to drink, including social pressures, stressful situations, or environmental triggers.
The present study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders.
The present study was based on a sample of 166 adolescents recruited during inpatient AOD abuse treatment. Included in this study were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Data for the present study were drawn from interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment.
Twenty six percent of participants had quit smoking for >1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Subjects associated with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points.
The significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behaviour may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviours. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes.
Although the prevalence of alcohol problems amongst detainees is suspected to be high, it seems that only the most flagrant problems are detected, thus considerably restricting the field for the intervention of experts in alcohol abuse and not providing an opportunity for preventive efforts. This study examined the re-test reliability of AUDIT (Alcohol Use Disorder Identification Test) in screening prisoners
AUDIT was administered for the first time on the day of entry to prison and again about 15 days later. The results were analysed according to two AUDIT thresholds: a score of 8 or higher and 12 or higher.
Of 75 consecutive entrants tested, 47 male prisoners completed the study. At the first administration, 19.1% of these 47 men met criteria for a probable alcohol problem but this percentage rose to 59.6% on the second occasion (p=0.0001). The proportion of subjects with a score 12 or higher (probably dependent) was 10.6% the first time versus 42.6% the second time (p=0.0001). In the 19 who scored positive at the 2nd administration only, changes in answers to the 10 items were coherent with a total score growing from 3.0 to 18.1 (p=0.0001). No prisoner had a lower AUDIT score on the 2nd administration. As alcohol problems are not routinely considered during the medical and biological examination at entry, no confirmation of the AUDIT results could be obtained, although those obtained at the second administration fitted well with the prevalence rates in previous reports.
AUDIT, for the purpose of giving a prevalence estimate or to enter appropriate prisoners into more detailed assessment or interventions, should not be conducted immediately at entry, but some weeks later.
Adult; Alcoholism; diagnosis; epidemiology; psychology; France; Humans; Male; Prisoners; psychology; statistics & numerical data; Questionnaires; Alcoholism; Screening; prison; AUDIT; Offender