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1.  The Sponsor Alliance Inventory: Assessing the Therapeutic Bond Between 12-Step Attendees and Their Sponsors 
Aims
Within 12-step mutual-help organizations (MHOs), a sponsor plays a key recovery-specific role analogous to a ‘lay therapist’, serving as a role model, support and mentor. Research shows that attendees who have a sponsor have higher rates of abstinence and remission from substance use disorder (SUD), yet, while myriad formal psychotherapy studies demonstrate the therapeutic significance of the alliance between patients and professional clinicians on treatment outcomes, very little is known about the influence of the ‘therapeutic alliance’ between 12-step members and their sponsor. Greater knowledge about this key 12-step relationship could help explain greater degrees of 12-step effects. To bridge this gap, this study sought to develop and test a measure assessing the 12-step sponsee–sponsor therapeutic alliance—the Sponsor Alliance Inventory (SAI).
Method
Young adults (N = 302) enrolled in a prospective effectiveness study who reported having a 12-step sponsor during the study (N = 157) were assessed at treatment entry, and 3, 6 and 12 months later on the SAI, their 12-step MHO attendance, involvement and percent days abstinent (PDA).
Results
Principal axis extraction revealed a single, 10-item, internally consistent (α's ≥ 0.95) scale that explained the majority of variance and was largely invariant to primary substance, gender and time. Criterion validity was also supported with higher SAI scores predicting greater proximal 12-step attendance, involvement and PDA.
Conclusion
The SAI may serve as a brief, valid measure to assess the degree of sponsee–sponsor ‘therapeutic alliance’ within 12-step communities and may help augment explanatory models estimating the effects of MHOs on recovery outcomes.
doi:10.1093/alcalc/agv071
PMCID: PMC4804117  PMID: 26113488
2.  Understanding Lay Assessments of Alcohol Use Disorder: Need for Treatment and Associated Stigma 
Aims
Three-quarters of people with an alcohol use disorder in the USA never receive treatment. Our understandings of who receives care are informed by sociological perspectives, theories and models, each of which discuss the role of lay people's understanding of illness. However, comparatively little work has been done to unpack the cognitive processes underlying lay assessment. In the context of the Framework Integrating Normative Influences on Stigma (FINIS), we aim to understand key factors guiding lay people's stigmatizing attitudes, perceptions and assessments of alcohol use disorder behaviors.
Methods
Lay people read a vignette depicting a male or female adult with a diagnosable alcohol use disorder, along with either a causal life-event explanation for the alcohol use disorder behaviors or no explanation. They then made judgments of the need for treatment, psychological abnormality and the stigma they felt toward the person depicted.
Results
Causal life-event explanations decreased lay judgments of the need for treatment, psychological abnormality and stigma.
Conclusions
The results suggest that the availability of a causal life-event explanation may have a complex effect on lay judgments, decreasing the likelihood of recommending treatment for alcohol use disorders, yet simultaneously reducing stigmatizing perceptions (and presumably social distance).
doi:10.1093/alcalc/agv069
PMCID: PMC4678947  PMID: 26113491
3.  Impulsivity as a Multifaceted Construct Related to Excessive Drinking Among UK Students 
Aims
A substantial number of university students exceed alcohol guidelines. Impulsivity has been repeatedly implicated in heavy alcohol use, yet despite knowledge that impulsivity is multifaceted, there have previously been few studies applying multiple measures of self-report and behavioural impulsivity to examine the relationship with excessive student drinking. This results in a limited understanding of the relationship of various facets of impulsivity to student drinking.
Methods
Participants completed a comprehensive battery of impulsivity measures: the Barratt Impulsiveness Scale as a self-report index and the Stop Signal Task, Information Sampling Task and Monetary Choice Questionnaire as behavioural measures of three facets of impulsivity. Participants who exceeded UK drinking guidelines were compared to those who did not on measures of impulsivity. Hierarchical linear regression was then employed to test whether indices of impulsivity were associated with the average units consumed per week.
Results
Participants who exceeded UK guidelines reported increased impulsivity in facets of self-report impulsivity. They also displayed performance deficits in normal adjustment of Go responses on the Stop Signal Task. In the regression model, nonplanning impulsivity on the Barratt Impulsiveness Scale was seen to predict quantity of alcohol consumed per month.
Conclusions
The study applies a comprehensive selection of behavioural and self-report measures of impulsivity and indicates that excessive drinkers are more impulsive in some but not all aspects. The results indicate that the wide range of deficits apparent in alcohol-dependent individuals are not evident in this younger, heavy drinking population, but that specific performance and self-identified deficits are already apparent.
doi:10.1093/alcalc/agv070
PMCID: PMC4678948  PMID: 26115988
4.  Measuring Alcohol Consumption in Population Surveys: A Review of International Guidelines and Comparison with Surveys in England 
Aims
To review the international guidelines and recommendations on survey instruments for measurement of alcohol consumption in population surveys and to examine how national surveys in England meet the core recommendations.
Methods
A systematic search for international guidelines for measuring alcohol consumption in population surveys was undertaken. The common core recommendations for alcohol consumption measures and survey instruments were identified. Alcohol consumption questions in national surveys in England were compared with these recommendations for specific years and over time since 2000.
Results
Four sets of international guidelines and three core alcohol consumption measures (alcohol consumption status, average volume of consumption, frequency and volume of heavy episodic drinking) with another optional measure (drinking context) were identified. English national surveys have been inconsistent over time in including questions that provide information on average volume of consumption but have not included questions on another essential alcohol consumption measure, frequency of heavy episodic drinking. Instead, they have used questions that focus only on maximum volume of alcohol consumed on any day in the previous week.
Conclusions
International guidelines provide consistent recommendations for measuring alcohol consumption in population surveys. These recommendations have not been consistently applied in English national surveys, and this has contributed to the inadequacy of survey measurements for monitoring vital aspects of alcohol consumption in England over recent years.
doi:10.1093/alcalc/agv073
PMCID: PMC4678949  PMID: 26115987
5.  Does Industry-Driven Alcohol Marketing Influence Adolescent Drinking Behaviour? A Systematic Review 
Aim
To systematically review evidence on the influence of specific marketing components (Price, Promotion, Product attributes and Place of sale/availability) on key drinking outcomes (initiation, continuation, frequency and intensity) in young people aged 9–17.
Methods
MEDLINE, EMBASE, SCOPUS, PsychINFO, CINAHL and ProQuest were searched from inception to July 2015, supplemented with searches of Google Scholar, hand searches of key journals and backward and forward citation searches of reference lists of identified papers.
Results
Forty-eight papers covering 35 unique studies met inclusion criteria. Authors tended to report that greater exposure to alcohol marketing impacted on drinking initiation, continuation, frequency and intensity during adolescence. Nevertheless, 23 (66%) studies reported null results or negative associations, often in combination with positive associations, resulting in mixed findings within and across studies. Heterogeneity in study design, content and outcomes prevented estimation of effect sizes or exploration of variation between countries or age subgroups. The strength of the evidence base differed according to type of marketing exposure and drinking outcome studied, with support for an association between alcohol promotion (mainly advertising) and drinking outcomes in adolescence, whilst only two studies examined the relationship between alcohol price and the drinking behaviour of those under the age of 18.
Conclusion
Despite the volume of work, evidence is inconclusive in all four areas of marketing but strongest for promotional activity. Future research with standardized measures is needed to build on this work and better inform interventions and policy responses.
doi:10.1093/alcalc/agw085
PMCID: PMC5169036  PMID: 27864186
6.  Analysis of Price Changes in Washington Following the 2012 Liquor Privatization 
Aims
In June, 2012 the state of Washington ended a wholesale and retail monopoly on liquor sales resulting in about five times as many stores selling liquor. Three-tier restrictions were also removed on liquor, while beer and wine availability did not increase. Substantial taxes at both the wholesale and retail levels were implemented and it was expected that prices would rise.
Methods
To evaluate price changes after privatization we developed an index of about 68 brands that were popular in Washington during early 2012. Data on final liquor prices (including all taxes) in Washington were obtained through store visits and on-line sources between November 2013 and March of 2014. Primary analyses were conducted on five or six brand indexes to allow the inclusion of most stores.
Results
Washington liquor prices rose by an average of 15.5% for the 750 ml size and by 4.7% for the 1.75 l size, while only small changes were seen in the bordering states of Oregon and Idaho. Prices were found to vary greatly by store type. Liquor Superstores had generally the lowest prices while drugstore, grocery and especially smaller Liquor Store prices were found to be substantially higher.
Conclusion
Our findings indicate that liquor prices in Washington increased substantially after privatization and as compared to price changes in bordering states, with a much larger increase seen for the 750 ml size and with wide variation across store types. However, persistent drinkers looking for low prices will be able to find them in certain stores.
doi:10.1093/alcalc/agv067
PMCID: PMC4608622  PMID: 26109262
7.  Differential Contributions of Alcohol and the Nicotine-Derived Nitrosamine Ketone (NNK) to Insulin and Insulin-Like Growth Factor Resistance in the Adolescent Rat Brain 
Aims
Since epidemiologic studies suggest that tobacco smoke toxins, e.g. the nicotine-derived nitrosamine ketone (NNK) tobacco-specific nitrosamine, can be a co-factor in alcohol-related brain disease (ARBD), we examined the independent and additive effects of alcohol and NNK exposures on spatial learning/memory, and brain insulin/IGF signaling, neuronal function and oxidative stress.
Methods
Adolescent Long Evans rats were fed liquid diets containing 0 or 26% caloric ethanol for 8 weeks. During weeks 3–8, rats were treated with i.p. NNK (2 mg/kg, 3×/week) or saline. In weeks 7–8, ethanol groups were binge-administered ethanol (2 g/kg; 3×/week). In week 8, at 12 weeks of age, rats were subjected to Morris Water Maze tests. Temporal lobes were used to assess molecular indices of insulin/IGF resistance, oxidative stress and neuronal function.
Results
Ethanol and NNK impaired spatial learning, and NNK ± ethanol impaired memory. Linear trend analysis demonstrated worsening performance from control to ethanol, to NNK, and then ethanol + NNK. Ethanol ± NNK, caused brain atrophy, inhibited insulin signaling through the insulin receptor and Akt, activated GSK-3β, increased protein carbonyl and 3-nitrotyrosine, and reduced acetylcholinesterase. NNK increased NTyr. Ethanol + NNK had synergistic stimulatory effects on 8-iso-PGF-2α, inhibitory effects on p-p70S6K, tau and p-tau and trend effects on insulin-like growth factor type 1 (IGF-1) receptor expression and phosphorylation.
Conclusions
Ethanol, NNK and combined ethanol + NNK exposures that begin in adolescence impair spatial learning and memory in young adults. The ethanol and/or NNK exposures differentially impair insulin/IGF signaling through neuronal growth, survival and plasticity pathways, increase cellular injury and oxidative stress and reduce expression of critical proteins needed for neuronal function.
doi:10.1093/alcalc/agv101
PMCID: PMC4608623  PMID: 26373814
8.  Differential Contributions of Alcohol and Nicotine-Derived Nitrosamine Ketone (NNK) to White Matter Pathology in the Adolescent Rat Brain 
Aim
Epidemiologic studies have demonstrated high rates of smoking among alcoholics, and neuroimaging studies have detected white matter atrophy and degeneration in both smokers and individuals with alcohol-related brain disease (ARBD). These findings suggest that tobacco smoke exposure may be a co-factor in ARBD. The present study examines the differential and additive effects of tobacco-specific nitrosamine (NNK) and ethanol exposures on the structural and functional integrity of white matter in an experimental model.
Methods
Adolescent Long Evans rats were fed liquid diets containing 0 or 26% ethanol for 8 weeks. In weeks 3–8, rats were treated with nicotine-derived nitrosamine ketone (NNK) (2 mg/kg, 3×/week) or saline by i.p. injection. In weeks 7–8, the ethanol group was binge-administered ethanol (2 g/kg; 3×/week).
Results
Ethanol, NNK and ethanol + NNK caused striking degenerative abnormalities in white matter myelin and axons, with accompanying reductions in myelin-associated glycoprotein expression. Quantitative RT-PCR targeted array and heatmap analyses demonstrated that ethanol modestly increased, whereas ethanol + NNK sharply increased expression of immature and mature oligodendroglial genes, and that NNK increased immature but inhibited mature oligodendroglial genes. In addition, NNK modulated expression of neuroglial genes in favor of growth cone collapse and synaptic disconnection. Ethanol- and NNK-associated increases in FOXO1, FOXO4 and NKX2-2 transcription factor gene expression could reflect compensatory responses to brain insulin resistance in this model.
Conclusion
Alcohol and tobacco exposures promote ARBD by impairing myelin synthesis, maturation and integrity via distinct but overlapping mechanisms. Public health measures to reduce ARBD should target both alcohol and tobacco abuses.
doi:10.1093/alcalc/agv102
PMCID: PMC4608624  PMID: 26373813
9.  Association Between Alcohol Sports Sponsorship and Consumption: A Systematic Review 
Aim
Concerns have been raised about the impact of alcohol sports sponsorship on harmful consumption, with some countries banning this practice or considering a ban. We review evidence on the relationship between exposure to alcohol sports sponsorship and alcohol consumption.
Methods
Search of electronic databases (PubMed, Cochrane Library, Google Scholar and International Alcohol Information Database) supplemented by hand searches of references and conference proceedings to locate studies providing data on the impact of exposure to alcohol sports sponsorship and outcomes relating to alcohol consumption.
Results
Seven studies met inclusion criteria, presenting data on 12,760 participants from Australia, New Zealand, the UK, Germany, Italy, Netherlands and Poland. All studies report positive associations between exposure to alcohol sports sponsorship and self-reported alcohol consumption, but the statistical significance of results varies. Two studies found indirect exposure to alcohol sports sponsorship was associated with increased levels of drinking amongst schoolchildren, and five studies found a positive association between direct alcohol sports sponsorship and hazardous drinking amongst adult sportspeople.
Conclusion
These findings corroborate the results of previous systematic reviews that reported a positive association between exposure to alcohol marketing and alcohol consumption. The relationship between alcohol sports sponsorship and increased drinking amongst schoolchildren will concern policymakers. Further research into the effectiveness of restrictions on alcohol sports sponsorship in reducing harmful drinking is required.
doi:10.1093/alcalc/agw006
PMCID: PMC5091292  PMID: 26911984
10.  Underestimating the Alcohol Content of a Glass of Wine: The Implications for Estimates of Mortality Risk 
Aims
Increases in glass sizes and wine strength over the last 25 years in the UK are likely to have led to an underestimation of alcohol intake in population studies. We explore whether this probable misclassification affects the association between average alcohol intake and risk of mortality from all causes, cardiovascular disease and cancer.
Methods
Self-reported alcohol consumption in 1997–1999 among 7010 men and women in the Whitehall II cohort of British civil servants was linked to the risk of mortality until mid-2015. A conversion factor of 8 g of alcohol per wine glass (1 unit) was compared with a conversion of 16 g per wine glass (2 units).
Results
When applying a higher alcohol content conversion for wine consumption, the proportion of heavy/very heavy drinkers increased from 28% to 41% for men and 15% to 28% for women. There was a significantly increased risk of very heavy drinking compared with moderate drinking for deaths from all causes and cancer before and after change in wine conversion; however, the hazard ratios were reduced when a higher wine conversion was used.
Conclusions
In this population-based study, assuming higher alcohol content in wine glasses changed the estimates of mortality risk. We propose that investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses. Prospectively, researchers need to collect more detailed information on alcohol including serving sizes and strength.
Short summary
The alcohol content in a wine glass is likely to be underestimated in population surveys as wine strength and serving size have increased in recent years. We demonstrate that in a large cohort study, this underestimation affects estimates of mortality risk. Investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses.
doi:10.1093/alcalc/agw027
PMCID: PMC5004746  PMID: 27261472
11.  Understanding the Role of Context-Specific Drinking in Neglectful Parenting Behaviors 
Aims
Child neglect is the most common form of child maltreatment, yet little is known about how drinking context may be related to particular subtypes of child neglect. This study examines the relationship between parental drinking in multiple contexts and the use of supervisory and physical neglectful.
Methods
A sample of 2152 parents of children 12 years or younger in 50 cities in California was obtained using a computer-assisted telephone interview. Past-year prevalence of child neglect was measured using the Multidimensional Neglectful Behavior Scale. Information was collected on past month or past-year frequency of having at least one drink in five contexts, continued drinking measures (e.g. number of drinks after the first drink) and sociodemographics. Data were analyzed using multilevel random effects logit models.
Results
Frequency of drinking in various contexts was related to different neglect subtypes. Specifically, frequency of drinking with friends was positively related leaving a child home alone when an adult should be present. Parents who drank more frequently with family were less likely to leave their child home alone in the past year yet more likely to unsafely monitor their child in the past year. Drinking at parties more often was related to being more likely to leave a child alone in a car sometime during the past year.
Conclusions
That no single drinking context is universally problematic for supervisory and physical neglect suggests that different social mechanisms may underlie the relationships observed between different drinking contexts and neglect subtypes.
doi:10.1093/alcalc/agv031
PMCID: PMC4537517  PMID: 25810450
12.  Ethosuximide Reduces Mortality and Seizure Severity in Response to Pentylenetetrazole Treatment During Ethanol Withdrawal 
Aims
We recently demonstrated that T-type calcium channels are affected by alcohol abuse and withdrawal. Treatment with ethosuximide, an antiepileptic drug that blocks T-type calcium channels, reduces seizure activity induced by intermittent ethanol exposures and withdrawals. Here, we expand on these findings to test whether ethosuximide can reduce the sensitivity to pentylenetetrazole-induced seizures during ethanol withdrawal.
Methods
We used an intermittent ethanol exposure model to produce withdrawal-induced hyperexcitability in DBA/2J mice.
Results
Ethosuximide (250 mg/kg) reduced seizure severity in mice undergoing ethanol withdrawal with concurrent PTZ treatment (20 mg/kg). Importantly, ethosuximide did not produce rebound excitability and protected against ethanol withdrawal-induced mortality produced by concurrent PTZ treatment (40 mg/kg).
Conclusion
These results, in addition to previous preclinical findings, suggest that ethosuximide should be further evaluated as a safe, effective alternative to benzodiazepines for the treatment of alcohol withdrawal.
doi:10.1093/alcalc/agv033
PMCID: PMC4537518  PMID: 25870316
13.  Racial/Ethnic Disparities in the Risk of Injury Related to the Frequency of Heavy Drinking Occasions 
Aims
To estimate the risk of injury associated with the frequency of heavy drinking days overall and for black, white and Hispanic drinkers in a US sample.
Methods
Data are from the 2010 National Alcohol Survey and included 6506 respondents comprising the landline sample. Analyses utilize Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking is determined by age of onset and questions on heavy drinking by decade of life. The outcome measure is having had a serious injury at a certain age. Models estimate the risk of injury in relation to heavy drinking in each year controlling for demographics, risk taking and time varying measures of smoking and chronic disease.
Results
Results indicate that the risk of injury increases with the frequency of heavy drinking days to a hazard ratio of 2.14 (1.45–3.14) for daily heavy drinkers. Risks for white respondents were similar to the overall results but different risk relationships were found for black respondents among whom only daily heavy drinkers had increased risk of 4.09 (2.11–7.93), and for Hispanic respondents where elevated risk was seen among yearly heavy drinkers 2.71 (1.29–5.68), with a similar risk estimate for monthly heavy drinkers but lower and non-significant risks found for more frequent heavy drinking categories.
Conclusions
Different risk relationships were found across race/ethnicity groups suggesting elevated risk with less frequent heavy drinking among Hispanic respondents and very high risk from daily heavy drinking among black respondents.
doi:10.1093/alcalc/agv044
PMCID: PMC4537519  PMID: 25972516
14.  The Association of Alcohol Severity and Sleep Quality in Problem Drinkers 
Aims
The association between alcohol use and sleep problems is well established and clinically meaningful, particularly as predictors of relapse. This study aims to elucidate the relationship between sleep disturbances and alcohol problems in a non-treatment-seeking community sample using an alcoholism problem severity factor.
Methods
Participants were problem drinkers (N = 295) from the Los Angeles community who had a breath alcohol content (BrAC) of 0.00 g/dl when they completed an in-person assessment battery comprised of measures of sleep quality, anxiety and depression, cigarette smoking, as well as multiple assessments of alcohol use and alcohol use problems.
Results
A series of hierarchical regressions showed that alcohol problem severity explained a significant amount of variance in sleep disturbance beyond demographic, mood and smoking variables. Alcohol problem severity was predictive of the PSQI global score (B = 1.11, P < 0.001), perceived sleep quality factor (B = 0.18, P < 0.001) and daily disturbance factor (B = 0.28, P < 0.001). However, contrary to study hypothesis, alcohol problem severity was predictive of improved sleep efficiency (B = −0.14, P < 0.05).
Conclusions
In sum, alcohol problem severity may be predictive of sleep disturbances. Given the complex nature of these relationships, further work is needed to develop adequate treatment for sleep disturbance during alcohol recovery. Nonetheless, this study suggests that as alcohol problem severity increases so do sleep problems. Thus, attending to sleep problems at early stages of alcohol problems may be warranted.
doi:10.1093/alcalc/agv046
PMCID: PMC4537520  PMID: 26018218
15.  Assessing the Validity of Participant-Derived Compared to Staff-Derived Values to Compute a Binge Score 
Aims
This study examined the validity of two methods of classifying binge drinkers.
Methods
Adult drinkers (n = 166) completed the Alcohol Use Questionnaire (AUQ) and a Timeline Followback (TLFB) interview to characterize drinking during the past 28 days. Using Townshend and Duka's (2005) recommendations, answers on three AUQ items (average drinks per hour, number of times drunk within the prior 6 months and percentage of times drunk when drinking) were used to derive a binge score that was then used to classify drinkers as Binge, Non-Binge and Unclassifiable. Two methods for calculating binge scores were compared: (a) Participant-derived, using participants' answers on the 3 AUQ items; and (b) Staff-derived, staff used TLFB interview information to answer the 3 AUQ items. Additionally, Participant- and Staff-derived classifications were used to predict future drinking behaviors assessed by a second TLFB interview.
Results
Participant- and Staff-derived binge scores had a low concordance rate. Staff-derived classifications were better than Participant-derived classifications at predicting future binge drinking behavior and identifying group differences in drinking behavior reported during the second TLFB interview (average drinks per hour, number of times drunk within the prior 6 months, and percentage of times drunk when drinking).
Conclusions
Classifying drinkers using staff-guided TLFB interview methods instead of self-reported participant generalizations of typical drinking habits better relates to real-world drinking. Classification schemes that rely on dichotomous categorization of drinkers (Binge vs. Non-Binge) may be missing individuals who engage in harmful patterns of drinking. A continuous scale or index characterizing problematic drinking may be more useful.
doi:10.1093/alcalc/agv018
PMCID: PMC4474000  PMID: 25770137
16.  Receiving Versus Being Denied a Pregnancy Termination and Subsequent Alcohol Use: A Longitudinal Study 
Aim
Research finds women who terminate pregnancies are at risk of subsequent problematic alcohol use, but methodological and conceptual problems are common. This study examines the relationship between receiving versus being denied termination and subsequent alcohol use.
Methods
Data are from a prospective, longitudinal study of US women seeking pregnancy terminations. Participants presented just before a facility's gestational limit and received terminations (Near Limits, n = 452) or just beyond the limit and were denied terminations (Turnaways, n = 231).
Results
Groups did not differ in alcohol use before pregnancy recognition. One week after termination-seeking (Turnaways still pregnant, Near Limits not), Turnaways had lower odds of any and binge alcohol use, but did not differ on 1+ problem symptoms. Over 2.5 years, both Near Limits and Turnaways increased any and binge alcohol use, with Turnaways increasing more rapidly. The groups did not converge again on any or binge use. For Near Limits, any alcohol use surpassed the pre-pregnancy recognition level, but binge use did not. Changes in problem symptoms over time were not evident for either group.
Conclusion
While women who had a termination were more likely to report any and binge alcohol use than women who had a child, this difference was due to a reduction in consumption among women having the child rather than an increase in consumption among women having a termination. Thus, assertions that having a termination leads women to increase alcohol use to cope with having had a termination are not supported.
doi:10.1093/alcalc/agv021
PMCID: PMC4474001  PMID: 25787011
17.  Alcohol Outcome Expectancies and Regrettable Drinking-Related Social Behaviors 
Aims
Research has shown that alcohol outcome expectancies are predictive of heavy alcohol consumption, which can lead to risky behavior. The purpose of the present study was to assess the incidence of various low-risk social behaviors while drinking among college students. Such social behaviors may later be regretted (referred to as regrettable social behaviors) and include electronic and in-person communications.
Methods
College students (N = 236) completed measures of alcohol outcome expectancies and regrettable social behaviors.
Results
Regrettable social behaviors were reported by 66.1% of participants, suggesting that they may occur at a much higher rate than more serious drinking-related consequences (e.g. drinking and driving, violence, etc.). Expectancies for social facilitation predicted regrettable social behavior. Further, this relationship was mediated by amount of alcohol consumed.
Conclusion
Given the high incidence, regrettable social behaviors may be effective targets in alcohol prevention programming.
doi:10.1093/alcalc/agv026
PMCID: PMC4474002  PMID: 25820611
18.  Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours? 
Purpose: To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours.
Methods: Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up.
Results: Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours.
Conclusions: Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction.
doi:10.1093/alcalc/agv007
PMCID: PMC4398989  PMID: 25731180
19.  The Relationship Between Population-Level Exposure to Alcohol Advertising on Television and Brand-Specific Consumption Among Underage Youth in the US 
Aims: We investigated the population-level relationship between exposure to brand-specific advertising and brand-specific alcohol use among US youth.
Methods: We conducted an internet survey of a national sample of 1031 youth, ages 13–20, who had consumed alcohol in the past 30 days. We ascertained all of the alcohol brands respondents consumed in the past 30 days, as well as which of 20 popular television shows they had viewed during that time period. Using a negative binomial regression model, we examined the relationship between aggregated brand-specific exposure to alcohol advertising on the 20 television shows [ad stock, measured in gross rating points (GRPs)] and youth brand-consumption prevalence, while controlling for the average price and overall market share of each brand.
Results: Brands with advertising exposure on the 20 television shows had a consumption prevalence about four times higher than brands not advertising on those shows. Brand-level advertising elasticity of demand varied by exposure level, with higher elasticity in the lower exposure range. The estimated advertising elasticity of 0.63 in the lower exposure range indicates that for each 1% increase in advertising exposure, a brand's youth consumption prevalence increases by 0.63%.
Conclusions: At the population level, underage youths' exposure to brand-specific advertising was a significant predictor of the consumption prevalence of that brand, independent of each brand's price and overall market share. The non-linearity of the observed relationship suggests that youth advertising exposure may need to be lowered substantially in order to decrease consumption of the most heavily advertised brands.
doi:10.1093/alcalc/agv016
PMCID: PMC4398991  PMID: 25754127
20.  The Role of Expectation in the Therapeutic Outcomes of Alcohol and Drug Addiction Treatments 
Throughout history, patient–physician relationships have been acknowledged as an important component of the therapeutic effects of any pharmacological treatment. Here, we discuss the role of physicians' expectations in influencing the therapeutic outcomes of alcohol and drug addiction pharmacological treatments. As largely demonstrated, such expectations and attitudes may contribute to produce placebo and nocebo effects that in turn affect the course of the disease and the response to the therapy. This article is aimed at discussing the current insights into expectations, placebo and nocebo mechanisms and their impact on the therapeutic outcomes of alcohol and drug addiction treatments; with the goal of informing physicians and other health care providers about the potentially widespread implications for clinical practice and for a successful treatment regimen.
doi:10.1093/alcalc/agv015
PMCID: PMC4415067  PMID: 25761920
21.  Inconsistency in Reporting Abstention and Heavy Drinking Frequency: Associations with Sex and Socioeconomic Status, and Potential Impacts 
Aims: To describe inconsistencies in reporting past-year drinking status and heavy drinking occasions (HDOs) on single questions from two different instruments, and to identify associated characteristics and impacts.
Methods: We compared computer-presented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) with categorical response options, and mental health interview (MHI) with open-ended consumption questions, completed on the same day. Participants were 464 men and 459 women aged 38 (91.7% of surviving birth cohort members). Differences in dichotomous single-item measures of abstention and HDO frequency, associations of inconsistent reporting with sex, socioeconomic status (SES) and survey order, and impacts of instrument choice on associations of alcohol with sex and SES were examined.
Results: The AUDIT-C drinking frequency question estimated higher past-year abstention prevalence (AUDIT = 7.6%, MHI = 5.4%), with one-third of AUDIT-C abstainers being MHI drinkers. Only AUDIT-C produced significant sex differences in abstainer prevalence. Inconsistencies in HDO classifications were bidirectional, but with fewer HDOs reported on the MHI than AUDIT-C question. Lower SES was associated with inconsistency in abstention and weekly+ HDOs. Abstention and higher HDO frequency were associated with lower SES overall, but sex-specific associations differed by instrument.
Conclusions: In this context, data collection method affected findings, with inconsistencies in abstention reports having most impact. Future studies should: (a) confirm self-reported abstention; (b) consider piloting data collection methods in target populations; (c) expect impacts of sex and SES on measurements and analyses.
doi:10.1093/alcalc/agu106
PMCID: PMC4481535  PMID: 25648932
22.  Potential Contributions of the Tobacco Nicotine-Derived Nitrosamine Ketone (NNK) in the Pathogenesis of Steatohepatitis in a Chronic Plus Binge Rat Model of Alcoholic Liver Disease 
Aims: Alcoholic liver disease (ALD) is linked to binge drinking and cigarette smoking. Heavy chronic ± binge alcohol, or low-level exposures to dietary nitrosamines cause steatohepatitis with insulin resistance and oxidative stress in animal models. This study examines hepatotoxic effects of sub-mutagenic exposures to tobacco-specific nitrosamine (NNK) in relation to ALD. Methods: Long Evans rats were fed liquid diets containing 0 or 26% (caloric) ethanol (EtOH) for 8 weeks. In Weeks 3 through 8, rats were treated with NNK (2 mg/kg) or saline by i.p. injection, 3×/week, and in Weeks 7 and 8, EtOH-fed rats were binge-administered 2 g/kg EtOH 3×/week; controls were given saline. Results: EtOH ± NNK caused steatohepatitis with necrosis, disruption of the hepatic cord architecture, ballooning degeneration, early fibrosis, mitochondrial cytopathy and ER disruption. Severity of lesions was highest in the EtOH+NNK group. EtOH and NNK inhibited insulin/IGF signaling through Akt and activated pro-inflammatory cytokines, while EtOH promoted lipid peroxidation, and NNK increased apoptosis. O6-methyl-Guanine adducts were only detected in NNK-exposed livers. Conclusion: Both alcohol and NNK exposures contribute to ALD pathogenesis, including insulin/IGF resistance and inflammation. The differential effects of EtOH and NNK on adduct formation are critical to ALD progression among alcoholics who smoke.
doi:10.1093/alcalc/agu083
PMCID: PMC4327341  PMID: 25618784
23.  Increased Alcohol Consumption in Urocortin 3 Knockout Mice Is Unaffected by Chronic Inflammatory Pain 
Aims: Stress neurocircuitry may modulate the relationship between alcohol drinking and chronic pain. The corticotropin-releasing factor (CRF) system is crucial for regulation of stress responses. The current study aimed to elucidate the role of the endogenous CRF ligand Urocortin 3 (Ucn3) in the relationship between alcohol drinking behavior and chronic pain using a genetic approach. Methods: Ucn3 (KO) and wildtype (WT) littermates were subjected to a 24-h access drinking procedure prior to and following induction of chronic inflammatory pain. Results: Ucn3 KO mice displayed significantly increased ethanol intake and preference compared with WT across the time course. There were no long-term effects of chronic pain on alcohol drinking behavior, regardless of genotype, nor any evidence for alcohol-induced analgesia. Conclusion: The increased drinking in Ucn3 KO supports a role for this peptide in alcohol-related behavior. These data suggest the necessity for more research exploring the relationship between alcohol drinking, chronic pain and the CRF system in rodent models.
doi:10.1093/alcalc/agu084
PMCID: PMC4327342  PMID: 25451237
24.  Drinking Patterns and Victimization among Male and Female Students in Mexico 
Aims: The purpose of this study is to estimate the prevalence of alcohol use and alcohol-related consequences, identify drinking profiles using latent profile analysis (LPA), and investigate associations between profiles and violent victimization among young people in Mexico. Methods: LPA identified profiles of drinking behavior in a survey of entering first year university students. Multinomial and logistic regression examined associations between drinking patterns, socio-demographic variables and violent victimization. Results: The LPA identified five profiles of behaviors and consequences among the 22,224 current, former and never drinkers: Non/Infrequent-No Consequences, Occasional-Few Consequences, Regular-Some Consequences, Heavy-Many Consequences and Excessive-Many Consequences drinkers. The Occasional-Few Consequences profile comprised the largest, and the Excessive-Many Consequences profile the smallest, group of drinkers. Multinomial regression showed males and older students more likely to be Heavy or Excessive-Many Consequences drinkers. Living alone was associated with higher odds, and higher maternal education with lower odds, of being a Non/Infrequent-No Consequences drinker. Heavier drinking profiles were more likely to experience violent victimization adverse consequences. Logistic regression showed male and female Heavy and Excessive-Many Consequences drinkers had the highest odds, and Non/Infrequent drinkers the lowest odds, of experiencing any victimization. Conclusion: Findings suggest changes in male and female drinking behavior and a continuation of the established pattern of infrequent but high consumption among Mexican youths. Both male and female Heavy and Excessive-Many Consequences drinkers were at elevated risk for experiencing victimization. Identifying cultural gender norms about drinking including drinker expectations and drinking context that contribute to these patterns can inform prevention efforts.
doi:10.1093/alcalc/agu092
PMCID: PMC4327343  PMID: 25534933
25.  Relationship Between Emotional Processing, Drinking Severity and Relapse in Adults Treated for Alcohol Dependence in Poland 
Aims: Growing data reveals deficits in perception, understanding and regulation of emotions in alcohol dependence (AD). The study objective was to explore the relationships between emotional processing, drinking history and relapse in a clinical sample of alcohol-dependent patients. Methods: A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland was recruited and assessed at baseline and follow-up after 12 months. Baseline information about demographics, psychopathological symptoms, personality and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence (EI) Test and Toronto Alexithymia Scale (TAS) were utilized for emotional processing assessment. Follow-up information contained data on drinking alcohol during the last month. Results: At baseline assessment, the duration of alcohol drinking was associated with lower ability to utilize emotions. Patients reporting more difficulties with describing feelings drank more during their last episode of heavy drinking, and had a longer duration of intensive alcohol use. A longer duration of the last episode of heavy drinking was associated with more problems identifying and regulating emotions. Poor utilization of emotions and high severity of depressive symptoms contributed to higher rates of drinking at follow-up. Conclusions: These results underline the importance of systematic identification of discrete emotional problems and dynamics related to AD. This knowledge has implications for treatment. Psychotherapeutic interventions to improve emotional skills could be utilized in treatment of alcohol-dependent patients.
doi:10.1093/alcalc/agu099
PMCID: PMC4327344  PMID: 25543129

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