Alcohol and Alcoholism - Advance Access

Psychological Distress in Non-Drinkers: Associations with Previous Heavy Drinking and Current Social Relationships

Lucas, N., Windsor, T. D., Caldwell, T. M., Rodgers, B. — Mon, 16 Nov 2009 07:09:22 PST

Aims: The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association. The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers. Methods: A national cross-sectional survey yielded data from 2856 Australians aged 20–22, 30–32 and 40–42 years (response rate 15.9%). Results: The sample was representative for many socio-demographic factors but under-represented people not in the labour force and over-represented those with university qualifications. In the oldest but not the younger age groups, abstainers reported significantly higher psychological distress relative to light/moderate drinkers. While abstainers in the oldest age group who were former heavy drinkers showed the highest levels of distress, excluding them from the analysis did not account for differences in distress between current abstainers and light/moderate drinkers. Abstainers aged 40–42 years were less socially integrated, less extraverted and had lower social support than light/moderate drinkers, and controlling for these factors partially explained their increased distress. Conclusions: Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40–42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.

Asperger Syndrome and Alcohol--Drinking to Cope? By Matthew Tinsley and Sarah Hendricks

Soni, S. — Mon, 16 Nov 2009 07:09:22 PST

Planned and Unplanned Discharge from Alcohol Services in Scotland, 2004-2008

Newham, R., Russell, C., Davies, J. B. — Thu, 12 Nov 2009 06:05:59 PST

Aims: Available data suggests that the rate of unplanned discharge from alcohol treatment services is an international problem reflective, perhaps, of ambivalence surrounding treatment in general. Given Scotland's escalating prevalence of alcohol misuse, a preliminary study of Scottish dropout rates would make a useful contribution to the international scene. Methods: A retrospective analysis of discharge statuses (planned/unplanned/disciplinary) of entries to alcohol treatment services between 1 April 2004 and 31 March 2008 was conducted on data provided by 10 regional Drug and Alcohol Action Teams (DAATs) and three individual treatment providers. Results: Of 48,299 cases, 52.23% (n = 25,231) were unplanned discharges. Data showed a general increasing trend in the rate of planned discharges across the examined 4-year period, from 41.66% in 2004–2005 to 51.94% in 2007–2008. Inspection of the data revealed marked regional variations in ratios of planned to unplanned discharge, with only four of the 10 regions examined reporting a planned discharge rate >50%. Conclusion: More than one of every two entries to alcohol misuse services between 2004 and 2008 resulted in an unplanned discharge. The trend of improvement over the examined 4-year period was not consistent for all regions. A comparison of this figure with available US and Welsh data is made. The importance of these data in assessing the cost-effectiveness of alcohol treatment services and implications for policy making is discussed.

Drugs, Intoxication and Society. By Angus Bancroft

Paton, A. — Thu, 05 Nov 2009 02:13:49 PST

Cluster-randomized Controlled Trial of Dissemination Strategies of an Online Quality Improvement Programme for Alcohol-related Disorders

Wed, 04 Nov 2009 08:27:12 PST

Aims: This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany. Methods: In a cluster-randomized controlled trial, 112 general practices were randomized into three groups. The first group (n = 43) received access to the online system and a training programme for the general practitioners (GPs). The second group (n = 42) additionally received education for the whole practice team. The third group (n = 27) acted as control and received only access to the online system. Results: Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034). Conclusions: No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable.

The study is registered at ClinicalTrials.gov: NCT00314067.

This article conforms to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement (Moher et al., 2001; Campbell et al., 2004).

Addiction Medicine. By Noeline Latt, Katherine Conigrave, John B. Saunders, E. Jane Marshall and David Nutt

Paton, A. — Wed, 04 Nov 2009 08:27:10 PST

Polymorphisms in Alcohol Metabolizing Genes and the Risk of Head and Neck Cancer in a Brazilian Population

Garcia, S. M. N., Curioni, O. A., de Carvalho, M. B., Gattas, G. J. F. — Tue, 03 Nov 2009 03:49:46 PST

Aims: The incidence of head and neck cancer (HNC) in Brazil has increased substantially in recent years. This increase is likely to be strongly associated with alcohol and tobacco consumption, but genetic susceptibility also should be investigated in this population. The aim of this study was to evaluate the association of polymorphisms in genes of alcohol metabolism enzymes and the risk of HNC. Methods: A hospital-based case–control study was conducted in São Paulo, Brazil. We here investigated ADH1C Ile³⁵⁰Val, ADH1B Arg⁴⁸His, ADH1B Arg³⁷⁰Cys and CYP2E1*5A PstI polymorphisms by PCR-RFLP Polymerase Chain Reaction - Restriction Fragment Length Polymorphism in 207 histopathologically confirmed HNC cases (184 males and 23 females) and 244 cancer-free controls (225 males and 19 females) admitted as in-patients in the same hospital. Results: Chronic alcohol intake increased approximately four times the risk of HNC. The mutant genotype ADH1B Arg⁴⁸His was more frequent in controls (12.7%) than HNC patients (5.8%) conferring protection for the disease (odds ratio (OR) = 0.42; 95% confidence interval (CI ), 0.21–0.85). Similar results were observed for individuals with ADH1B*2 (OR = 0.41; 95% CI , 0.20–0.82) or ADH1B*2/ADH1C*1 (OR = 0.32; 95% CI , 0.13–0.79) mutated haplotypes. Multiple regression analyses showed that individuals with the mutant genotype ADH1B Arg⁴⁸His who consume alcohol >30 g/L/day have more than four times the risk for HNC (OR = 4.42; 95% CI, 1.21–16.11). Conclusions: The fast alcohol metabolizing genotypes may prevent HNC when the amount of alcohol intake is <30.655 g/L/day.

Augmented Stress-Induced Alcohol Drinking and Withdrawal in Mice Lacking Functional Natriuretic Peptide-A Receptors

Tue, 13 Oct 2009 21:28:19 PDT

Aims: Preclinical and clinical data suggest an involvement of atrial natriuretic peptides (ANP) in alcohol-associated psychopathology. We now present first data on alcohol drinking behaviour in mice lacking a functional natriuretic peptide-A (NPR-A) receptor. Methods: NPR-A^–/– and wild-type mice were given a free choice between water and increasing concentrations of alcohol (2–16%). A forced swim stress was performed thereafter on three consecutive days to investigate stress-induced alcohol drinking. Additionally, neurobehavioural alcohol withdrawal response was investigated following 14 days of forced-alcohol intake. Results: Whereas basal alcohol intake did not differ between NPR-A mutants and wild-type littermates, NPR-A mutants showed an increased stress-induced alcohol intake and aggravated neurobehavioural symptoms of alcohol withdrawal. Conclusions: Mice lacking a functional NPR-A receptor represent a useful model to study the role of the ANP system in alcohol-associated pathology. To study the role of the natriuretic NPR-A gene for the modulation of risk of alcohol-related disorders, NPR-A-related polymorphisms should be targeted in clinical studies.

Deficits in Affective Prosody Comprehension: Family History of Alcoholism versus Alcohol Exposure

Sorocco, K. H., Monnot, M., Vincent, A. S., Ross, E. D., Lovallo, W. R. — Fri, 09 Oct 2009 06:34:22 PDT

Background: Abstinent alcoholics have deficits in comprehending the affective intonation in speech. Prior work suggests that these deficits are due to alcohol exposure rather than preexisting risk factors for alcoholism. The present paper examines whether family history of alcoholism is a contributor to affective prosody deficits in alcoholics. Methods: Fifty-eight healthy, nonabusing young adults with and without a family history of alcoholism or other substance abuse (29 FH+ and 29 FH–) were compared on affective prosody comprehension using the Aprosodia Battery. A secondary analysis was done comparing affective prosody comprehension in FH+ and FH– detoxified alcoholics from an earlier study (17 FH+ and 14 FH–). Results: Performance on the Aprosodia Battery was not related to FH status in either the healthy, nonabusing sample or in the detoxified alcoholic group. Conclusions: The present study lends support to previous research suggesting that deficits in affective prosody comprehension observed in detoxified alcoholics are associated with a history of heavy drinking rather than with a family history of alcoholism.

Glutamate Dehydrogenase as a Marker of Alcohol Dependence

Kravos, M., Malesic, I. — Wed, 07 Oct 2009 08:06:44 PDT

Aims: The aim of this study was to examine glutamate dehydrogenase (GLDH) in the diagnostic combinations as a result of new findings. Methods: GLDH, gama-glutamyltransferase (GGT), aspartate-aminotranferase (AST), alanine-aminotransferase (ALT) and erythrocyte mean cell volume (MCV) were assessed three times in 238 alcoholics admitted to hospital: on admission, after 24 h and after 7 days. Results: All the values were significantly higher than those in healthy persons. The fastest activity decrease was seen in GLDH. The kinetics of GLDH and AST were more applicable than GGT kinetics after a week, but GLDH kinetics were most reliable. GLDH was the most specific laboratory marker with almost 90% specificity. The sensitivity of combination MCV and GLDH kinetics after 1 week of abstinence was pathognomonic by 97.2%. This decision tree gave us a model with 84.5% accuracy. Conclusions: GLDH is an equally accurate marker of alcoholism in comparison to others, if its significantly faster decrease is taken into consideration. We strongly believe that watching changes in the activity of laboratory markers of alcoholism is an effective yet overlooked aid.

Towards DSM-V: Exploring Diagnostic Thresholds for Alcohol Dependence and Abuse

Grove, R., McBride, O., Slade, T. — Tue, 06 Oct 2009 09:15:26 PDT

Aims: The expected release of the DSM-V in 2012 has renewed the longstanding debate around whether alcohol use disorders are best conceptualized as dimensional or categorical constructs. The current study aimed to validate the current diagnostic thresholds for alcohol dependence and abuse using epidemiological indicators including mental health, disability, psychological distress, functional impairment, service use, suicidality and early age of drinking onset. Methods: Dichotomous variables were created to allocate a representative sample of Australian adult drinkers (n = 4920) above and below each possible threshold for both disorders. Regression analyses were conducted to assess group differences at each threshold for each epidemiological indicator. Results: There was some albeit limited support for the current diagnostic threshold of three criteria for alcohol dependence and one criterion for abuse. A number of other cut-offs also showed consistent variation for both disorders. Conclusions: It is essential to define diagnostic thresholds in a systematic way. The current diagnostic thresholds for alcohol dependence and abuse are adequate but require further validation using a variety of methods and external indicators. Combining these disorders in some way may also prove useful as well as including other potential diagnostic criteria in future research.

Relationship between Alcohol Consumption and Active Helicobacter pylori Infection

Zhang, L., Eslick, G. D., Xia, H. H.-X., Wu, C., Phung, N., Talley, N. J. — Tue, 06 Oct 2009 09:15:24 PDT

Background: Helicobacter pylori (H. pylori) is a cause of chronic gastritis and maybe responsible for functional dyspepsia in a subset of patients. Many risk factors, such as alcohol consumption and smoking, may contribute to the colonization and infection of H. pylori in humans. However, studies on the relationship between H. pylori infection and drinking or smoking have produced conflicting results. Objective: The aim of this study was to examine whether consumption of alcohol or smoking is associated with active H. pylori infection in functional dyspepsia patients. Methods: H. pylori infection was confirmed by CLOtest and histology on at least two biopsies. Active chronic gastritis was diagnosed using the updated Sydney system. In addition to gender and age, information on drinking and smoking habits was collected using a standard questionnaire. Functional dyspepsia was diagnosed according to the Rome II diagnostic criteria. Results: H. pylori infection was positive in 27.3% of the 139 functional dyspepsia patients. Both age and gender were not significantly associated with H. pylori infection. A multiple logistic model found that alcohol consumption (OR = 9.05, 95% CI: 1.05–77.98) and pathology (active gastritis) (OR = 595.39, 95% CI: 81.43–4353.33) were associated with H. pylori infection. Active gastritis was associated with alcohol consumption (OR = 2.89, 95% CI: 1.03–8.02), smoking (OR = 2.72, 95% CI: 1.22–6.05) and age (OR = 1.03, 95% CI: 1.01–1.06). Conclusions: In patients with functional dyspepsia, there is no significant association between active H. pylori infection and smoking. However, alcohol consumption appears to be associated with H. pylori infection.

Methodological Assessment of Economic Evaluations of Alcohol Treatment: What Is Missing?

Barbosa, C., Godfrey, C., Parrott, S. — Tue, 06 Oct 2009 09:15:22 PDT

Aim: The aim of this study is to review the methodology that has been adopted in previous economic evaluations of alcohol treatment and offer research recommendations with a view to enhancing the consistency and harmonization of economic evaluations in the alcohol field. Methods: Published full economic evaluations of alcohol treatment were retrieved using a systematic search. The studies were analysed in terms of the identification, measurement and valuation methods used to assess the society-level consequences and the methods used to carry out the analysis of individual-level consequences and costs of the intervention. A taxonomy of alcohol-related consequences was developed and used as a framework for the methodology extraction. Results: Twenty- seven studies were selected. Almost half of the studies did not include society-level consequences in their analysis. Some consequences of alcohol treatment at a societal level, such as the impact of treatment on health-related quality of life of family and friends of the drinker, have never been considered in the economic analysis. There was no agreement regarding the individual health consequences used in the evaluations. Measures capturing life years and morbidity have not been extensively used in the alcohol field. The level of reporting treatment costs on the reviewed studies is generally well detailed. Conclusion: The literature is still rather sparse in this area and further research is required to fulfil the gaps. If a common methodology is adopted in future economic evaluations of alcohol treatment, more stable cost-effectiveness estimates will be produced and informed decisions for resources allocation to alcohol treatments will be possible.

The Long Arm of Expectancies: Adolescent Alcohol Expectancies Predict Adult Alcohol Use

Patrick, M. E., Wray-Lake, L., Finlay, A. K., Maggs, J. L. — Tue, 06 Oct 2009 09:15:20 PDT

Aims: Alcohol expectancies are strong concurrent predictors of alcohol use and problems, but the current study addressed their unique power to predict from adolescence to midlife. Method: Long-term longitudinal data from the national British Cohort Study 1970 (N = 2146, 59.8% female) were used to predict alcohol use and misuse in the mid-30s by alcohol expectancies reported in adolescence. Results: Cohort members with more positive alcohol expectancies at age 16 reported greater alcohol quantity concurrently, increases in alcohol quantity relative to their peers between ages 16 and 35, and a higher likelihood of lifetime and previous year alcohol misuse at age 35, independent of gender, social class in family of origin, age of alcohol use onset, adolescent delinquent behavior and age 16 exam scores. Conclusions: Alcohol expectancies were strong proximal predictors of alcohol use and predicted relative change in alcohol use and misuse across two decades into middle adulthood.

Impact of Tryptophan Metabolism on the Vulnerability to Alcohol-Related Blackouts and Violent Impulsive Behaviours

Wed, 16 Sep 2009 10:02:44 PDT

Aims: We examined (1) the association of SLC6A4 genotypes and alcohol dependence (AD) in a sample of alcoholics; (2) the validity of lifetime occurrence of blacked-out violent impulsive behaviour (BOVIB) during binge drinking bouts as a criterion for subtyping AD patients and (3) a mechanistic hypothesis for BOVIB involving tryptophan-2,3-dioxygenase (TDO) activity. Methods: Three common polymorphisms of the SLC6A4 gene (5-HTTLPR, A/G SNP of LPR region and VNTR in intron 2) were genotyped. An oral tryptophan (Trp) load (OTL) was administered to a sample of patients seeking help for AD. BOVIB history and psychological status were screened by BOVIB-Q, depression (BDI), anxiety (BAI, STAI) and personality (TCI) questionnaires. During the 7 h following Trp load, serum kynurenine (Kyn) and Trp were monitored. Results: BOVIB+ patients showed significantly higher scores on depression, anxiety and character scales but no significant association was found between SLC6A4 polymorphisms and BOVIB. Patients with a history of BOVIB (BOVIB+ subgroup) differed from those exempt from such episodes (BOVIB– subgroup) for TDO activity response to OTL assessed by the Kyn:Trp ratio (P = 0.043) and the slope of concentration increase ratio (SCIR) of serum Kyn (P = 0.043). Conclusions: Put together, these findings support the validity of the BOVIB criterion to differentiate a sub-group of vulnerable AD subjects and suggest that OTL may help to concurrently define a specific endophenotype.

Dopamine D2 Receptor Genotype Is Associated with Increased Mortality at a 10-Year Follow-up of Alcohol-Dependent Individuals

Tue, 04 Aug 2009 04:44:14 PDT

Aims: Because the TAQ1 A1 allele may be associated with alcohol-related medical illnesses, and medical illnesses in alcohol-dependent individuals are associated with increased mortality, we test the hypothesis that the TAQ1 A1 allele of the DRD2 gene is associated with increased mortality in alcohol-dependent individuals. Methods: Following an index treatment episode, a 10-year follow-up study in 366 alcohol-dependent individuals was performed. The TAQ1 A1/A2 DRD2 genotype and allele frequencies were compared between those deceased and those still living at the 10-year point. In addition, the genotype and allele frequencies of these alcohol-dependent individuals were compared to that in 578 control subjects. Results: The prevalence of the A1 allele differed between the deceased and living patients and the controls: 47% of the deceased were A1+, compared to 37% of the living patients and 32% of the controls. The frequency of the TAQ1 A1/A2 genotype also differed between the groups. Thus, 43% had the A1/A2 genotype in comparison with 32% in the living patients and 29% in the controls. The TAQ 1 A1 allele frequency differed between the groups. The frequency of A1 allele was 25% in the deceased patients compared to 21% in the living patients and 17% in the controls. Conclusion: The TAQ I A1 allele of the DRD2 gene (or DRD2 gene region) was associated with increased mortality over a 10-year period in alcohol-dependent individuals.