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Alcohol and Alcoholism - RSS feed of recent issues (covers the latest 3 issues, including the current issue)

What Price for an Extra-ordinary Commodity? 31 Aug 2010

Substitution and Complementarity in the Face of Alcohol-Specific Policy Interventions 31 Aug 2010

Aim: Policy responses to the growing burden of alcohol-related disease fail to consider the interrelated nature of substance misuse and the potential for complex interactions in response to alcohol-specific interventions. This paper considers possible aggregate level responses to the alcohol policy and whether alcohol policy can be expected to reduce overall harm. Methods: A review and discussion of the relevant literature was conducted. Results: Evidence indicates that those at greatest risk consume stronger alcoholic beverages more frequently, that they are likely to complement their consumption with a range of intoxicants and that they are more likely to substitute alcohol with other substances. Conclusions: Policies aimed at reducing alcohol consumption can be successful. However, evidence suggests a significant minority of consumers are likely to substitute or complement consumption with a range of intoxicants suggesting that policy is unlikely to reduce all-cause mortality and morbidity. Further research into the nature of substitution and complementarity is required.

Something Must Be Done!: But Is Moore Correct that Something Can Be Worse than Nothing in Alcohol Control Policy? 31 Aug 2010

Asking the Right Questions about Substitution and Complementarity: A Comment on Moore's Paper 31 Aug 2010

Alcohol Use Disorders Affect Antimicrobial Proteins and Anti-pneumococcal Activity in Epithelial Lining Fluid Obtained via Bronchoalveolar Lavage 31 Aug 2010

Aims: Our overall objective was to examine whether characteristics of epithelial lining fluid (ELF) from subjects with alcohol use disorders (AUDs) obtained via bronchoalveolar lavage (BAL) contribute to their predisposition to pneumococcal pneumonia. We sought to compare the anti-pneumococcal activity of acellular human BAL from subjects with AUDs to matched controls. Further, differences in BAL lysozyme activity and lactoferrin concentrations between these two groups were examined to determine the effect of AUDs on these antimicrobial proteins. Methods: BAL was performed in subjects with AUDs and matched controls. Acellular BAL was used at varying concentrations in an in vitro killing assay of Streptococcus pneumoniae, type 2, and the percent kill of organisms per microgram per milliliter total BAL protein was ascertained. Lysozyme activity and lactoferrin concentrations were measured in BAL from subjects and controls at measured concentrations of BAL protein. Results: AUD subjects (n = 15) and controls (n = 10) were enrolled in these investigations who were balanced in terms of smoking history. Using a mixed effect model, across the range of BAL protein concentrations, killing of pneumococcus tended to be less potent with BAL fluid from AUD subjects. Additionally, lysozyme activity and lactoferrin concentrations were significantly lower in the AUD group. Conclusions: The predisposition for pneumococcal pneumonia among those with AUDs may be in part mediated through effects of alcohol on substances within ELF that include antimicrobial proteins. Clarifying the composition and activity of ELF antimicrobial proteins in the setting of AUDs via investigations with human BAL fluid can help establish their contribution to the susceptibility for pulmonary infections in these individuals.

The Changes of Sialic Acid Concentration and Content in Apolipoprotein B-Containing Lipoproteins in the Sera of Alcoholics 31 Aug 2010

Aims: The aim of this study was to investigate the changes associated with alcohol abuse in the structure and metabolism of lipoproteins, in particular, the content of sialic acid (SA). Methods: The level of SA in apolipoprotein B (apoB)-containing lipoproteins was determined by using enzymatic assay followed by the precipitation step in 126 alcohol-dependent men. Results: Increased level and content of SA in apoB-containing lipoproteins was found not only in the hyperlipidemic alcoholic subjects but also in normolipidemic subjects. The highest value was observed in alcoholics with type IIb of hyperlipidemia followed by type IV, IIa and normolipidemia. The increase of SA level in apoB-containing lipoproteins in type IIb hyperlipidemia is accompanied by an increase of serum apoB concentration. Increased level and content of SA in apoB-containing lipoproteins did not correlate with any markers of alcohol abuse and lipid status. Conclusions: There are changes in the structure of atherogenic lipoproteins in alcoholics, which consist of increasing SA concentration in apoB-containing lipoproteins. These changes are independent of serum apoB level and may precede the development of hyperlipidemia.

Bone Mineral Density, Bone Turnover Markers and Cytokines in Alcohol-Induced Cirrhosis 31 Aug 2010

Aims: Liver cirrhosis is a risk factor for osteoporosis. However, the pathogenesis of the bone mass loss in patients with alcohol-induced cirrhosis (AC) is not well understood. Serum concentrations of soluble tumour necrosis factor receptor (sTNF-R55), neopterin and soluble interleukin 2 receptor (sIL-2R), activation markers of cellular immunity, correlate with clinical activity and severity of the AC. The aim of this study is to evaluate the association of these soluble markers with the development of osteoporosis in patients with AC. Methods: We studied 33 consecutive patients with AC and 24 healthy volunteers. Bone mineral density (BMD) was measured by X-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN). Neopterin was measured by radioimmunoassay. Serum concentrations of sTNF-R55 and sIL-2R were measured by enzyme immunoassay. We also determined serum levels of osteocalcin and bone alkaline phosphatase as biochemical markers of bone formation, and deoxypyridinoline urinary excretion (D-Pyr) as marker of bone resorption. Results: Patients with AC had reduced BMD (expressed as z-score) in all sites (LS: P < 0.001 and FN: P < 0.05). Serum concentrations of sTNF-R55 were significantly higher in patients with both AC and osteoporosis than in those with only AC (P < 0.001). Serum levels of sTNF-R55 positively correlated with D-Pyr urinary excretion (r = 0.354; P = 0.01). Serum levels of sIL-2R were significantly higher in patients with both AC and osteoporosis than in those with only AC (P < 0.05). Conclusions: There is a relation between activation of the cellular immunity and osteoporosis in AC. Bone mass loss could be related to the increased bone resorption found in these patients.

Sweet Liking and High Novelty Seeking: Independent Phenotypes Associated with Alcohol-related Problems 31 Aug 2010

Aim: We tested the hypothesis that high novelty seeking (NS; a trait that promotes experimentation) and hedonic response to sweet taste (a trait that may reflect processing of hedonic stimuli) act independently to increase the risk for having alcohol-related problems in young adults. Methods: The study was conducted in 158 healthy subjects (age 20–25 years) with no lifetime history of alcohol and/or drug abuse/dependence. NS was evaluated using the Tridimensional Personality Questionnaire. Pleasurable response to sweet taste was tested, using a sweet taste test to identify sweet likers (SL; those preferring the strongest offered sucrose solution) and sweet dislikers (SDL; those preferring weaker sucrose solutions). Results: NS score, but not SL/SDL status, was positively correlated with drinks per month (P = 0.0054) and drinks per drinking day (P = 0.021). When tested individually, both NS and SL/SDL status predict having alcohol-related problems (NS: odds ratio [OR] = 5.3, P = 0.0016 and SL/SDL: OR = 5.8, P = 0.0001) with an OR similar to positive family history of alcoholism status (OR = 5.7, P = 0.0007). The combination of SL status and high NS score (greater than gender-specific 70th percentile) greatly increased the estimated odds of having alcohol-related problems (OR 27.5, P < 0.0001). Conclusions: These results support the hypothesis that high NS and SL phenotypes are independently associated with risk of alcohol-related problems. The combination of both phenotypes greatly increases the likelihood of alcohol-related problems. Although confirmation is necessary, this suggests that these phenotypes could contribute to improved methods to assess risk for alcohol-related problems and provide additional insight into processes underlying progression to alcohol-related problems.

fMRI BOLD Response in High-risk College Students (Part 1): During Exposure to Alcohol, Marijuana, Polydrug and Emotional Picture Cues 31 Aug 2010

Aim: This functional magnetic resonance imaging (fMRI) study examined reactivity to alcohol, polydrug, marijuana and emotional picture cues in students who were referred to a college alcohol and drug assistance program. Methods: The fMRI data of 10 participants (5 females; 5 males) were collected while they viewed standardized emotional and appetitive cues. Results: Positive and negative emotional cues produced greater activity than neutral cues in the expected brain areas. Compared with neutral cues, alcohol cues produced greater brain activation in the right insula, left anterior cingulate, left caudate and left prefrontal cortex (Z = 2.01, 1.86, 1.82, 1.81, respectively; P < 0.05). Drug cues produced significantly greater left prefrontal activity compared with neutral cues, with polydrug cues activating the right insula and marijuana cues activating left anterior cingulate. Conclusions: Students at-risk for alcohol abuse showed neural reactivity to alcohol cues in four brain regions, which is consistent with their greater use of alcohol. Insula activation to appetitive cues may be an early marker of risk for progression to alcohol/drug abuse.

fMRI BOLD Response of High-risk College Students (Part 2): During Memory Priming of Alcohol, Marijuana and Polydrug Picture Cues 31 Aug 2010

Aims: This study examined brain activity using functional magnetic resonance imaging (fMRI) and reaction time (RT) during an implicit repetition priming memory task involving alcohol, polydrug, marijuana and emotional picture cues. Methods: Participants were 5 male and 5 female high-risk college students who had just participated in a cue exposure study (Ray et al., this issue). fMRI and RT data were collected while participants made decisions about previously seen and new picture cues. Results: Both behavioral RT and brain imaging data revealed strong memory priming for drug and alcohol cues. Neurologically, a repetition priming effect (suppression in neural activity for repeated cues) was observed in response to alcohol cues in the left prefrontal, bilateral occipital, and bilateral occipitotemporal regions, as well as right insula and right precuneus (Z ranged from 3.03 to 3.31 P < 0.05). Polydrug cues elicited priming in the occipital and temporal areas, and marijuana cues in the occipital area. Conclusions: Prefrontal and insular cortex involvement both in reactivity to alcohol cues (Ray et al., this issue) and subsequent implicit memory processing of these cues, as found in this study, suggests their potential role in the maintenance of high-risk alcohol use behaviors.

Acetyl-L-Carnitine for Alcohol Craving and Relapse Prevention in Anhedonic Alcoholics: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial 31 Aug 2010

Aim: The study aimed to evaluate the efficacy of acetyl-l-carnitine (ALC), at different doses, in relapse prevention and craving in anhedonic detoxified alcohol-dependent subjects. Method: Randomized, double-blind, placebo-controlled, pilot study in 64 alcohol-dependent anhedonic patients: 23 received ALC at a dose of 3 g/day, 21 received ALC at a dosage of 1 g/day and 20 were given placebo. Intensity of alcohol craving was evaluated by Visual Analogue Scale. Subjects were evaluated at the beginning of treatment and after 10, 30, 60 and 90 days. Results: Survival analysis showed that patients treated with ALC remained completely abstinent for longer than those treated with placebo (Z = –2.27; P < 0.05). From the 10th day onwards, a greater reduction of craving was observed in the ALC 1 g group than with placebo (P = 0.035). The two groups did not differ in the percentage of subjects remaining abstinent for the entire study period or the number of subjects who relapsed (defined as five or more standard drinks (four for women) on a single occasion or drinking on five or more days in 1 week). Conclusions: The results of this study suggest that ALC can reduce craving and the time to first drink. ALC use was safe. Further studies are needed to clarify to confirm, over longer periods, these short-term outcome benefits.

Changes in Alcohol Availability, Price and Alcohol-related Problems and the Collectivity of Drinking Cultures: What Happened in Southern and Northern Sweden? 31 Aug 2010

Aims: The aims of this study were to study whether alcohol-related self-reported problems follow the same pattern of changes in alcohol consumption in southern Sweden, assumed to be affected by a decrease in Danish spirits tax and by an increase in Swedish travellers’ import quotas, and to study whether the results obtained for southern and northern Sweden follow the predictions of Skog's theory of collectivity of drinking cultures. Methods: Analysis was carried out on a sample from the Swedish general population from southern and northern Sweden separately. Two indices such as impaired self-control/dependent behaviour and extrinsic problems for alcohol-related problems were computed and analysed in terms of sex, age, income and alcohol consumption level. Results: Although there were no huge changes in the number of persons reporting alcohol-related problems, the general trend in data for various subpopulations was a decrease in the southern site and an increase in the northern site. In the northern site, the increase in alcohol consumption among men also showed an increase in alcohol-related problems. However, various population subgroups changed in different directions and did not move in concert over the population distribution. Conclusions: Analysis confirmed that alcohol-related problems, according to the two indices used, followed a similar pattern to alcohol consumption, but less divergent. A version of Skog's theory applied on alcohol-related problems could not confirm that alcohol-related problems did not change collectively within the population.

Effects of Changes in Availability of Alcohol: Unexpected Results Can Stimulate Theory Development and Research 31 Aug 2010

The Impact of Alcohol Marketing on Youth Drinking Behaviour: A Two-stage Cohort Study 31 Aug 2010

Aim: To examine whether awareness of, and involvement with alcohol marketing at age 13 is predictive of initiation of drinking, frequency of drinking and units of alcohol consumed at age 15. Methods: A two-stage cohort study, involving a questionnaire survey, combining interview and self-completion, was administered in respondents’ homes. Respondents were drawn from secondary schools in three adjoining local authority areas in the West of Scotland, UK. From a baseline sample of 920 teenagers (aged 12–14, mean age 13), in 2006, a cohort of 552 was followed up 2 years later (aged 14–16, mean age 15). Data were gathered on multiple forms of alcohol marketing and measures of drinking initiation, frequency and consumption. Results: At follow-up, logistic regression demonstrated that, after controlling for confounding variables, involvement with alcohol marketing at baseline was predictive of both uptake of drinking and increased frequency of drinking. Awareness of marketing at baseline was also associated with an increased frequency of drinking at follow-up. Conclusions: Our findings demonstrate an association between involvement with, and awareness of, alcohol marketing and drinking uptake or increased drinking frequency, and we consider whether the current regulatory environment affords youth sufficient protection from alcohol marketing.

Appropriate Research Designs for Evaluating Community-level Alcohol Interventions: What Next? 31 Aug 2010

Aim: The aim of this study was to explore the logistical and methodological strengths and weaknesses of some of the more common research designs which can be used to evaluate the impact of system- or population-level approaches for reducing alcohol-related harms. Method: This paper identifies studies that have evaluated system or population approaches to reduce alcohol-related harms. It highlights the tension caused by a desire for the most rigorous research designs, such as randomized controlled trials (RCTs), the most potentially efficacious interventions and the practical problems in applying the RCT to population-level research. Alternative research designs, which possess methodological rigour and are more feasible, are identified and described. The design with the strongest methodological characteristics and feasibility in allowing the evaluation of population interventions is considered to be the multiple baseline. Results: The multiple baseline design addresses potential problems of sample sizes, selection bias, the suitability and baseline stability of outcome measures, statistical analyses and the practicalities of conducting rigorous research in system- or population-level settings. Conclusion: The multiple baseline design has the capacity to allow methodologically and statistically stringent evaluations with relatively small sample sizes, low cost and fewer of the complications imposed by RCTs. Like all research designs it has limitations, but arguably represents the most practical and methodologically rigorous approach to the evaluation of system- or population-level strategies.

Professor Martin Andrew Plant (1946-2010) 21 Jun 2010

Circadian Clock Gene Polymorphisms in Alcohol Use Disorders and Alcohol Consumption 21 Jun 2010

Aims: Circadian clock genes are involved in the development of drug-induced behaviors and regulate neurotransmission pathways in addiction. Our aim was to study whether circadian clock gene polymorphisms predispose to alcohol dependence or abuse or other alcohol-related characteristics. Methods: The study sample comprised of 512 individuals having alcohol dependence or alcohol abuse (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)) and their 511 age- and sex-matched controls. This population-based sample was drawn from a cohort (n = 7415), representative of the Finnish general population aged 30 and over. Altogether 42 single-nucleotide polymorphisms of 19 genes related to the circadian pacemaker system were genotyped. Results: ARNTL rs6486120 T⁺ allelic status (P = 0.0007, q = 0.17), ADCYAP1 rs2856966 GG genotype (P = 0.0006, q = 0.17) and VIP CC haplotype (rs3823082–rs688136) (P = 0.0006) were suggestively associated with alcohol consumption in socially drinking controls. ARNTL2 GT haplotype (rs7958822–rs4964057) associated suggestively with alcohol abuse diagnosis (P = 0.0013). Earlier findings on the associations of DRD2 and NPY with alcohol dependence were supported: DRD2/ANKK1 Taq1A₁ increased (P = 0.04) and NPY Pro7 decreased (P = 0.01) the risk of alcohol dependence. Conclusions: ARNTL, ARNTL2, VIP and ADCYAP1 were indicated as having influence on alcohol use or abuse. The role of DRD2 and NPY on alcohol dependence was also supported.

Prenatal Alcohol Exposure Induces Long-Term Changes in Dendritic Spines and Synapses in the Mouse Visual Cortex 21 Jun 2010

Aims: To study the long-term changes of dendritic spine and synapse taking place in a mouse model of fetal alcohol spectrum disorders (FASDs). Methods: Pregnant mice were intubated daily with ethanol (EtOH) from E5 to parturition. A DiI diolistic method was used to label dendritic spines of pyramidal cells in the visual cortex of EtOH-exposed and control pups over the period from postnatal (P) day P0 to P30; synaptic ultrastructure was also analyzed using transmission electron microscopy. Results: Prenatal alcohol exposure was associated with a significant decrease in the number of dendritic spines of pyramidal neurons in the visual cortex and an increase in their mean length. The changes were dose dependent and persisted to P30. Ultrastructural changes were also observed, with decreased numbers of synaptic vesicles, narrowing of the synaptic cleft and thickening of the postsynaptic density compared to controls; ultrastructural changes also persisted to P30. Conclusions: Prenatal alcohol exposure is associated with long-term changes in dendritic spines and synaptic ultrastructure; these alterations probably reflect the developmental retardation of dendritic spines and synapses in visual cortex. These long-term changes are likely to contribute to lifelong mental retardation associated with childhood FASDs.

Saponins from Panax japonicus Protect Against Alcohol-Induced Hepatic Injury in Mice by Up-regulating the Expression of GPX3, SOD1 and SOD3 21 Jun 2010

Aims: The purpose of this study was to investigate the possible mechanism(s) of saponins from Panax japonicus (SPJ) on alcohol-induced hepatic damage in mice. Methods: SPJ were identified by high performance liquid chromatography-evaporative light scattering detection-mass spectrometry (LC–ELSD–MS). Non-toxic concentrations of SPJ were assayed on alcohol-induced hepatic injury in male ICR mice and human hepatic cells. The protective effects were evaluated by biochemical values, histopathological observations and the relative gene expression. Results. In vitro, SPJ showed significant hydroxyl radical scavenging capacity. In vivo, SPJ (50 mg/kg) could rectify the pathological changes of aspartate transaminase, alanine transaminase, malondialdehyde, reduced glutathione (GSH), glutathione peroxidase (GPX), catalase (CAT) and superoxide dismutase (SOD) caused by alcohol metabolism to normal levels except for hepatic GSH and CAT. In hepatic cells, the results were in agreement with foregoing results determined in mice after pretreatment of SPJ (100 µg/ml). RT–PCR results showed that CAT, GPX and SOD mRNA decreased by alcohol metabolism were reversed, in which GPX3, SOD1 and SOD3 could return to a normal level, but CAT, GPX1 and SOD2 mRNA were still evidently lower than the control. Histopathological observations provided supportive evidence for biochemical analyses. Conclusions: SPJ plays an important role in the protection of the structure and function of hepatic mitochondria and karyon by directly scavenging reactive oxygen species/free radicals and up-regulating the expression of antioxidant enzymes (SOD, GPX and CAT), especially to GPX3, SOD1 and SOD3.

Long-Term Modulations in the Vertebral Transcriptome of Adolescent-Stage Rats Exposed to Binge Alcohol 21 Jun 2010

Aims: Dangerous alcohol consumption practices are common in adolescents, yet little is known about their consequences on attainment of peak bone mass and long-term skeletal integrity. We previously demonstrated that binge alcohol-exposed adolescent rats showed site-specific reductions in accruement of bone mineral density and bone strength, which were incompletely recovered following prolonged alcohol abstinence. Currently, we analysed the vertebral transcriptome of adolescent rats following alcohol treatment and abstinence to identify long-term molecular changes in the lumbar spine. Methods: Sixty male adolescent Sprague-Dawley rats were assigned to one of six treatment groups receiving binge alcohol (3 g/kg) or saline i.p., 3 consecutive days (acute binge), 4 consecutive weekly (3-day) binge cycles (chronic binge) or 4 weekly binge cycles followed by a 30-day abstinence period (chronic binge with abstinence). Following treatment, lumbar vertebrae were assayed for global transcriptional changes using gene array technology. Results: Analysis of the adolescent rat vertebral transcriptome identified clusters of binge alcohol-sensitive genes displaying differential expression patterns starting before bone damage was seen and persisting after alcohol treatment was discontinued. Functional grouping of these gene clusters identified candidate cellular pathways affected following acute and chronic binge treatment, as well as pathways remaining modulated following abstinence. Conclusions: These results demonstrate that binge alcohol exposure can produce disruptions of normal bone gene expression patterns in the adolescent rat that persist well beyond the period of active intoxication. This data may have relevance to peak bone mass attainment and future risk of skeletal disease in adolescents engaging in repeated binge-drinking episodes.

Vascular Actions of Nitric Oxide as Affected by Exposure to Alcohol 21 Jun 2010

Vasodilator substances liberated from endothelial cells, mainly nitric oxide (NO), play important roles in physiologically regulating blood flow and blood pressure and preventing pathological vascular damage. Impairment of these actions promotes the genesis of cardiovascular diseases such as hypertension, cerebral and cardiac hypoperfusion, impaired vasodilatation and atherosclerosis. Low concentrations of alcohol induce increased release of NO from the endothelium due to activation and expression of NO synthase (NOS). In contrast, administration of high concentrations of alcohol or its chronic ingestion impairs endothelial functions in association with reduced NO bioavailability. The endogenous NOS inhibitor asymmetric dimethylarginine may participate in decreased synthesis of NO. Chronic alcohol intake also impairs penile erectile function possibly by interfering with endothelial, but not nitrergic nerve, function. This review article summarizes the vascular actions of NO derived from endothelial and neuronal NOS as affected by alcohol, other than wine, and acetaldehyde in healthy individuals, human materials and various experimental animals.

Comparing the Effectiveness of TWEAK and T-ACE in Determining Problem Drinkers in Pregnancy 21 Jun 2010

Aim: The TWEAK and T-ACE screening tools are validated methods of identifying problem drinking in a pregnant population. The objective of this study was to compare the effectiveness of the TWEAK and T-ACE screening tools in identifying problem drinking using traditional cut-points (CP). Methods: Study participants consisted of women calling the Motherisk Alcohol Helpline for information regarding their alcohol use in pregnancy. In this cohort, concerns surrounding underreporting are not likely as women self-report their alcohol consumption. Participant’s self-identification, confirmed by her amount of alcohol use, determined whether she was a problem drinker or not. The TWEAK and T-ACE tools were administered on both groups and subsequent analysis was done to determine if one tool was more effective in predicting problem drinking. Results: The study consisted of 75 problem and 100 non-problem drinkers. Using traditional CP, the TWEAK and T-ACE tools both performed similarly at identifying potential at-risk women (positive predictive value = 0.54), with very high sensitivity rates (100–99% and 100–93%, respectively) but poor specificity rates (36–43% and 19–34%, respectively). Upon comparison, there was no statistical difference in the effectiveness for one test performing better than next using either CP of 2 (P = 0.66) or CP of 3 (P = 0.38). Conclusion: Despite the lack of difference in performance, improved specificity associated with TWEAK suggests that it may be better suited to screen at-risk populations seeking advice from a helpline.

A Psychometric Validation of the Short Alcohol Withdrawal Scale (SAWS) 21 Jun 2010

Aims: The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS). Methods: One hundred and twenty-two patients with AD and AWS filled in a 10-item rating scale to describe their symptoms with four graduations on five physical and five psychological items. The question of dimensionality of the construct was addressed in three different ways. First, a scree plot was constructed based on the polychoric correlations between items. Second, promax factor loadings were calculated for a two-factor model. These two steps were based on exploratory factor analysis. Third, specific violations such as local dependence and differential item functioning were investigated under the one-factor model in a confirmatory factor analysis. Results: The scree plot supported one or two dimensions while the promax rotations gave little support for a two-factor model. The confirmatory analysis also supported a one-factor model. Conclusion: The decomposition of the polychoric correlation matrix into eigenvalues and vectors suggested that there was most likely one factor underlying the 10 items in the SAWS. This was confirmed by a confirmative factor analysis with only one component when specific model violations such as local dependence and differential item findings were investigated. The SAWS is easy to use.

Hydration Status and the Diuretic Action of a Small Dose of Alcohol 21 Jun 2010

Aim: This study was conducted to examine the effect of consuming a dilute alcohol solution (weak beer) on urine production in euhydrated and hypohydrated individuals. Methods: Twelve males completed an intermittent cycle protocol in hot (35.1 ± 0.3°C), humid (68 ± 2%) conditions to dehydrate by 1.9 ± 0.3% body mass in the evening. Twice they were then fed and rehydrated, while on two other occasions they were fed the same meal but remained hypohydrated. The following morning they were given 1 l of beer to drink. On two occasions the beer was alcohol-free, while on the other two occasions the same beer contained 4% ethanol. Participants remained in the laboratory for monitoring over the subsequent 4 h. Blood and urine samples were taken prior to dehydration, prior to drink administration and once every hour of the monitoring period. Results: No difference existed in the volume of urine produced between the alcohol (261 ± 138 ml; mean ± SD) and non-alcohol (174 ± 61 ml) beer when hypohydrated (P = 0.057), but there was a difference when euhydrated (1279 ± 256 vs 1121 ± 148 ml alcohol and non-alcohol, respectively; P < 0.001). Unsurprisingly, more urine was produced on both euhydrated trials than either of the hypohydrated trials (P < 0.001). Blood alcohol concentration was elevated (P < 0.001) 1 h after drinking to 7.1 ± 1.8 and 6.0 ± 2.7 mmol/l (hypohydrated and euhydrated, respectively) on the alcohol trials. Serum osmolality was higher 1 h after drinking on both the alcohol trials (303 ± 5 and 298 ± 5 mosmol/l) than on their non-alcohol, equivalent hydration trials (290 ± 8 and 284 ± 5 mosmol/l hypohydrated and euhydrated, respectively; P < 0.001).

Conclusion: These results suggest that the diuretic action of alcohol is blunted when the body is hypohydrated.

Quantifying Alcohol-Related Mortality: Should Alcohol-Related Contributory Causes of Death be Included? 21 Jun 2010

Aims: The aim of the study was to assess whether alcohol-related mortality data in the UK should be extended to include contributory as well as underlying cause of death. Methods: A total of 101,320 deaths registered in Northern Ireland between 2001 and 2007 were analysed to determine the quantity and characteristics of those with an underlying or contributory alcohol-related cause of death. Results: Alcohol was found to be an underlying cause of death in 1690 cases (1.7% of deaths) and a contributory cause in a further 1105 cases. Analyses show that the addition of alcohol-related contributory causes of deaths would increase the male–female ratio, result in steeper socio-economic gradients and amplify the apparent rate of increase of alcohol-related deaths. The significant contribution of alcohol to external causes of death, such as accidents and suicide, is also more evident. Conclusions: Using only underlying cause of death undoubtedly underestimates the burden of alcohol-related harm and may provide an inaccurate picture of those most likely to suffer from an alcohol-related death, especially among younger men.

Alcohol-Attributable Mortality in Ireland 21 Jun 2010

Aims: The study aim was to calculate Irish alcohol-attributable fractions (AAFs) and to apply these measurements to existing data in order to quantify the impact of alcohol on mortality. Methods: Exposure of the Irish population to alcohol was derived from a national survey and combined with estimates of the alcohol–disease/injury risk association from meta-analyses in the international literature to calculate Irish AAFs. In diseases for which relative risk estimates were not available, such as injury, AAFs were taken directly from Ridolfo and Stevenson [(2001) The quantification of drug-caused mortality and morbidity in Australia, 1998. In Drug Statistics Series no. 7. AIHW cat. no. PHE 29. Australian Institute of Health and Welfare, Canberra]. AAFs were applied to national datasets to calculate alcohol-attributed mortality caused or prevented and potential years of life lost (PYLL) or saved. Results: In Ireland, over the 5-year period from January 1, 2000 to December 31, 2004, alcohol was estimated to have caused 4.4% (6584) of deaths and 10.8% (131,245) of all-cause PYLL. Alcohol was estimated to have prevented 2.7% (3967) of deaths and 1.5% (18,285) of all-cause PYLL. This resulted in an estimated net effect of 1.8% (2616) of deaths and 9.3% (112,959) of all-cause PYLL. Chronic conditions were responsible for 69% of alcohol-attributable deaths and acute conditions for 31%. Conditions not wholly attributable to alcohol accounted for 83% of deaths as opposed to 17% for conditions wholly caused by alcohol. Conclusions: This study showed for the first time the full magnitude of deaths from alcohol in Ireland and revealed that while young people and those dependent on alcohol are at high risk of negative outcomes due to alcohol, particularly acute injuries, at an individual level, at a population level it is in fact moderate drinkers and chronic diseases, not wholly attributable to alcohol, that are associated with most alcohol-attributed deaths. The findings of this study suggest that policies focusing on the whole population attitude to alcohol, and chronic conditions and conditions partially attributable to alcohol, would yield considerable public health benefits.

Effective Prevention against Risky Underage Drinking -- The Need for Higher Excise Taxes on Alcoholic Beverages in Germany 21 Jun 2010

Aim: The study aimed to explore the place of taxation in preventing underage binge drinking in Germany. Method: We reviewed evidence on the role of excise taxes on alcohol in preventing alcohol problems and underage drinking. We analyzed historical German data on tax on alcoholic beverages and compared this with European data, finally calculating tax scenarios and their impact on underage binge drinking. Results: Germany applies lower taxes than many other European countries and alcohol beverage prices have decreased by 30% relative to overall price levels during the last 40 years. Conclusion: An optimal tax rate for reducing underage drinking would be set between the European average tax rates and Scandinavian tax rate levels.

Evaluation of a New Core Curriculum on Alcohol Use Disorders for Undergraduate Medical Students 21 Jun 2010

Aims: This study was aimed to review and rewrite the undergraduate curriculum on alcohol use disorders, implement the changes and assess for any early evidence of an improvement in knowledge. Methods: A three-stage process was used to review the old curriculum and a new one was designed around the five undergraduate years. Students' opinions were sought about the acceptability of the new curriculum using a questionnaire, to which 93 responded and 70 volunteers were objectively assessed using an examination based on questions from the text of the Medical Students' Handbook on Alcohol and Health. Results: There was no evidence of any improvement in the students' knowledge using the old curriculum. After teaching with the new curriculum, examination scores significantly increased (P < 0.0001). There was no difference between the sexes. The new curriculum was assessed as acceptable to the students. Conclusion: This new curriculum reflects the need for a new teaching method and not only offers improved teaching, but also produces a generation of doctors equipped to identify alcohol-related problems and to deliver brief interventions, helping to reduce the projected consequences of alcohol abuse and the associated burden on the health service.

Can Part of the Health Damage Linked to Alcohol Misuse in Scotland be Attributable to the Type of Drink and its Low Price (by Permitting a Rapid Rate of Consumption)? A Point of View 21 Jun 2010

This article considers two sets of data describing the extent of consumption of white spirit drinks by a sample of patients who abuse alcohol and the analysis of drink antioxidant content. We present a proposal for discussion that the rapid consumption of alcoholic drinks, low in protective antioxidant compounds, may potentially be more damaging to the body.

Persistent High Alcohol Consumption in Alcohol-Preferring (P) Rats Results from a Lack of Normal Aversion to Alcohol 20 Apr 2010

Aims: In this study, we tested the impact of pretreatment with alcohol on subsequent alcohol drinking in outbred Sprague–Dawley and selectively bred alcohol-preferring (P) rats. Methods: As a pretreatment, male Sprague–Dawley and P rats were given a passive oral administration of either alcohol (1.0 g/kg) or tap water. Then, they were given free choice of drinking alcohol (5% v/v) or water in their home cages, which was measured over 4 weeks. Results: Without alcohol pretreatment, there was no significant strain difference in alcohol preference; both strains preferred 5% (v/v) alcohol solution. The strain difference was only apparent in the groups given alcohol pretreatment. This arose from the fact that alcohol pretreatment significantly reduced alcohol preference in the Sprague–Dawley rats to a level well below 50%, while it did not alter drinking behavior in P rats. The same effects were seen with total alcohol consumption (g/kg/day). These effects persisted throughout the 4 weeks of the study. Conclusions: The principal difference between the Sprague–Dawley and P rats was that the P rats did not show the normal aversion to alcohol after forced exposure to alcohol that the Sprague–Dawley rats showed. One of the potential contributors to high alcohol intake and preference in P rats may be lack of sensitivity to aversive effects of alcohol.

Alcoholic Myopathy: Vitamin D Deficiency is Related to Muscle Fibre Atrophy in a Murine Model 20 Apr 2010

Aims: Chronic myopathy has been described in alcoholics, characterized by atrophy of type II fibres, and vitamin D deficiency. Low serum vitamin D levels are frequent in alcoholics. The possibility exists that serum vitamin D levels are related to muscle changes in a murine experimental model. Methods: Histological analysis of the right gastrocnemius muscle was performed in four groups of adult Sprague-Dawley rats, sacrificed after 5 weeks of treatment following the Lieber–DeCarli model. We studied the association between muscle histological changes and the activity of glutathione peroxidase (GPX), superoxide dismutase (SOD) and lipid peroxidation products (malondialdehyde); parathyroid hormone (PTH), insulin-like growth factor 1 (IGF-1), free testosterone, 1,25 dihydroxyvitamin D3 (vitamin D) and corticosterone; and serum calcium and magnesium. Results: Alcoholic animals showed type IIa and IIb fibre atrophy, especially the low-protein-fed ones, an effect dependent on protein deficiency. A significant relationship was observed between serum vitamin D levels and IIa fibre area ( = 0.56, P = 0.002), and also, as a trend, between vitamin D and type IIb fibre area ( = 0.39, p = 0.053); between vitamin D and muscle GPX ( = 0.40, P = 0.025) and SOD activities ( = 0.43, P = 0.012). Muscle GPX activity was significantly related with type I fibre area ( = 0.49, P = 0.01) and muscle SOD, with type IIa fibre area ( = 0.38, P = 0.045). Serum testosterone was also related with type IIa fibre area ( = 0.61, P < 0.001). No relation was observed between serum PTH, corticosterone, or IGF-1 and fibre area PTH and antioxidant systems. Multiple regression analysis disclosed that the only parameter independently related with type IIa fibre area was serum vitamin D. Conclusion: Low vitamin D levels are related to muscle fibre atrophy, and altered levels of muscle antioxidant enzymes could play a role in alcoholic myopathy.

The Effects of Gender and a Co-occurring Depressive Disorder on Neurocognitive Functioning in Patients with Alcohol Dependence 20 Apr 2010

Aims: The present study aims to examine neuropsychological impairments by comorbidity and gender among patients with alcohol dependence. Methods: The study sample is comprised of 123 subjects who fulfilled a Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) diagnosis of alcohol dependence from January 2006 to December 2007. Subjects were asked to complete the following psychological tests: the Barratt Impulsivity Scale (BIS), Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Color Trails Test. We compared the results of neuropsychological assessments based on two types of classifications: people with comorbid depression and people without comorbidity; females and males. Results: The immediate visual memory and the BIS scores in patients with comorbid depression were significantly different from the scores in patients without comorbidity. In addition, females performed significantly poorer on the Working Memory Index than males and had a later age of regular drinking. Conclusions: Further investigation of the mechanism associated with the gender difference on cognition and exploration of the temporal relationship between alcohol dependence and depressive disorder on the cognitive aspect is needed.

Non-right-handedness and Free Serum Testosterone Levels in Detoxified Patients with Alcohol Dependence 20 Apr 2010

Aims: The influence of testosterone on the extent of hemispheric dominance has been discussed not just during the first two trimesters of pregnancy but also later in life. An increase in free serum testosterone levels has been found during and after the detoxification phase of patients with alcohol dependence. Methods: In 250 participants (125 men and 125 women) with alcohol dependence immediately after the direct withdrawal phase (Day 21) and in 250 healthy age- and gender-matched participants, free testosterone in the serum was determined and handedness was assessed as a peripheral marker of central hemispheric dominance. Results: Patients with alcohol dependence were 2.7-fold (odds ratio, OR: 2.66; 95% confidence interval, CI: 1.62–4.38) and men 4.1-fold (OR: 4.12; 95% CI: 2.44–6.98) more likely to be non-right-handed (NRH). In addition to male gender, non-right-handedness and alcohol dependence contributed statistically significantly to higher serum testosterone levels. Testosterone values of patients with alcohol dependence differed significantly between the four different Lesch subtypes; in particular, participants with alcohol dependence classified according to Lesch subtype IV were found to have significantly higher serum testosterone levels (F = 20.5; P < 0.001) when compared to participants classified according to Lesch subtypes I–III. Conclusions: An alteration of hemispheric dominance and thus an exogenously modifiable neuronal plasticity may be demonstrated directly on a population at risk.

Distinct Effects of Protracted Withdrawal on Affect, Craving, Selective Attention and Executive Functions among Alcohol-Dependent Patients 20 Apr 2010

Aims: The present study examined the effects of protracted alcohol withdrawal on affectivity, craving, selective attention and executive functions (EFs) in alcohol-dependent patients. Methods: Selective attention (The D2 Cancellation Test), flexibility (Trail Making Test), inhibition (Stroop Task), decision making (Iowa Gambling Task), craving (Obsessive–Compulsive Drinking Scale) and state affectivity (Positive and Negative Affectivity Schedule) were assessed in alcohol-dependent patients (DSM-IV, n = 35) matched to non-alcohol-dependent participants (n = 22) at the onset (T1: day 1 or 2) and at the end (T2: days 14–18) of protracted withdrawal during rehab. Results: Alcohol-dependent patients' abilities to focus their attention on relevant information, to switch from one pattern to another, to inhibit irrelevant information and to make advantageous choices were lower than those of control participants during both times of a withdrawal cure. No effect of time emerged from analyses for selective attention and EF deficits. Conversely, significant differences between T1 and T2 were observed for craving and affect scores indicating a weakening of alcohol craving and negative affect as well as an improvement of positive affect among patients from onset to the end of cure. Conclusion: Control functions of the Supervisory Attentional System (Norman and Shallice, 1986) were impaired and did not improve during a 3-week withdrawal cure, whereas alcohol craving and negative state affectivity significantly improved in parallel during this period. Implications for understanding the clinical processes of withdrawal are discussed.

Use of Carbohydrate-Deficient Transferrin (CDT) and a Combination of GGT and CDT (GGT-CDT) to Assess Heavy Alcohol Consumption in Traffic Medicine 20 Apr 2010

Aims: Carbohydrate-deficient transferrin (CDT) has become widely used in traffic medicine to detect chronic alcohol abuse among subjects applying for driving-license renewal or regranting. By defining cut-off values in a large population of abstainers and moderate drinkers, we report on CDT, GGT–CDT (a combination of gamma-glutamylaminotransferase (GGT) and CDT) and the association between blood alcohol concentration (BAC) and CDT among Italian drivers. Methods: CDT was evaluated by a high performance liquid chromatography (HPLC)-based commercial kit in 652 abstainers or moderate drinkers, 603 drivers applying for driving-license regranting after a rehabilitation programme and 105 drivers involved in car accidents with blood alcohol concentration higher than the legal limit used in Italy (BAC >0.5g/l). GGT–CDT was calculated according to Sillanaukee and Olsson and Niemelä. BAC has been assessed by gas chromatography–mass spectrometry. Results: A common CDT cut-off (1.8%) and gender-specific GGT–CDT cut-off (4.15% for males, 3.56% for females) were calculated as 99.9th percentiles of the control population. Also, 3% and 27% of subjects were classified as CDT positive respectively among drivers applying for license regranting and drivers involved in car accidents. A significant association between BAC and both CDT values and CDT positivity was found, with a frequency up to 49% of CDT samples, suggesting chronic alcohol abuse, among drivers with BAC >2.5g/l. Concordance between CDT and GGT–CDT was only moderate (kappa = 0.44), with CDT performing better than GGT–CDT. Conclusions: A relevant proportion of drivers with high BAC are chronic abusers. GGT–CDT, previously validated with CDT immunoassays, should not be applied to traffic medicine in its current form and its performances re-evaluated with CDT measured by HPLC.

Screening and Brief Intervention for Risky Alcohol Consumption in the Workplace: Results of a 1-Year Randomized Controlled Study 20 Apr 2010

Aims: To assess the effectiveness of brief alcohol intervention on hazardous and harmful drinking in the 12-month period after a voluntary alcohol screening. Methods: At a large transport company, employees presenting to the occupational health services for a routine health and lifestyle check-up were offered to undertake an alcohol screening by means of self-report (the Alcohol Use Disorders Identification Test—AUDIT) and a biomarker (carbohydrate-deficient transferrin in serum—CDT). Those screening positive for the AUDIT and/or CDT were randomized to a brief or comprehensive intervention group or to a control group. An identical follow-up session was performed 12 months later. Results: Of 990 employees (68% men) that volunteered for the alcohol screening, 194 (20%) tested positive for the AUDIT and/or CDT. Among the 158 (81%) subjects who also attended the follow-up session, the frequency of positive screening results at baseline/follow-up were 51%/23% for the AUDIT (P < 0.0001) and 58%/34% (P < 0.0001) for CDT. However, there were no significant differences between the brief and comprehensive intervention groups or between the intervention groups and the control group. Conclusion: The results suggested that alcohol screening and brief intervention performed in connection with routine health and lifestyle examinations in the workplace may be effective in reducing alcohol consumption. Given the lack of difference in outcome between the intervention groups and the control group, alcohol screening may in itself cause reduction in drinking. In addition, at least some of the positive effect may be explained by regression towards the mean.

Twelve-Month Follow-up Results from a Randomized Controlled Trial of a Brief Personalized Feedback Intervention for Problem Drinkers 20 Apr 2010

Aims: To examine the impact of a web-based personalized feedback intervention, the Check Your Drinking (CYD; www.CheckYourDrinking.net) screener at 12-month follow-up.

Methods: Respondents (N = 185) were recruited from a general population telephone survey of Ontario, Canadian adults (≥18 years) by asking risky drinkers if they were willing to help develop and evaluate Internet-based interventions for drinkers. Those randomly assigned to the intervention condition were provided with the web address and a unique password to a study-specific copy of the CYD. Respondents assigned to the control condition were sent a written description of the different components of the CYD and asked how useful they thought each of the components might be. Respondents were followed up at 3, 6 and 12 months.

Results: By the 12-month follow-up, the impact of the intervention previously reported at 3 and 6 months of CYD on problem drinkers’ alcohol consumption was no longer apparent (P > 0.05).

Conclusions: Recognizing that many people with alcohol concerns will never seek treatment, recent years have seen an increase in efforts to find ways to take treatment to problem drinkers. The CYD is one such intervention that has a demonstrated effect on reducing alcohol consumption in the short term (i.e. 6 months). Other more intensive Internet-based interventions or interventions via other modalities may enhance this positive outcome over the short and long term among problem drinkers who would be otherwise unlikely to access treatment for their alcohol concerns.

www.ClinicalTrials.gov registration #NCT00367575.

RCT of Effectiveness of Motivational Enhancement Therapy Delivered by Nurses for Hazardous Drinkers in Primary Care Units in Thailand 20 Apr 2010

Aims: To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand. Methods: 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. Results: 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. Conclusion: 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.

Why is Disulfiram Superior to Acamprosate in the Routine Clinical Setting? A Retrospective Long-Term Study in 353 Alcohol-Dependent Patients 20 Apr 2010

Aims: To compare the long-term effectiveness of acamprosate (ACP) and disulfiram (DSF) in the treatment of alcohol dependence and their effectiveness in regard to patient characteristics, within a naturalistic outpatient treatment setting. Method: Retrospective data from 2002 to 2007 were analysed on 353 alcohol-dependent subjects in outpatient treatment, who, according to the patient’s and the clinician’s mutual decision, received either supervised DSF (with thrice-weekly appointments) or ACP (once-weekly appointments) following an inpatient alcohol detoxification treatment. Abstinence was assessed by alcohol breathalyzer, patients’ self-report, urine and serum analyses, and overall physicians’ rating. Results: Baseline data in terms of current addictive behaviour and course of disease differed between groups to the disadvantage of the DSF group; compared to the ACP group, subjects treated with DSF showed a longer duration of alcohol dependence, higher amounts of daily alcohol consumption and more alcohol detoxification treatments in their history. In follow-up, Kaplan–Meier survival analysis revealed significant differences between groups in the primary and secondary measures of outcome (P always <0.01). Time elapsed before the first alcohol relapse as well as attendance to outpatient treatment and cumulative alcohol abstinence achieved within outpatient treatment was explicitly longer in the DSF group. A longer duration of alcohol dependence predicted a favourable treatment outcome in the DSF group, while for the ACP group the chances for a successful treatment increased with shorter duration of alcohol dependence. Conclusions: This study supports the thesis that supervised DSF is an important component of alcoholism treatment, and it appears to be more effective than the treatment with ACP particularly in patients with a long duration of alcohol dependence.

Patterns of Alcohol Consumption in the Thai Population: Results of the National Household Survey of 2007 20 Apr 2010

Aims: The National Household Survey for Substance and Alcohol Use is a periodic survey of the Thai population with the aim of estimating the number of people who use licit and illicit substances. This paper reports the findings regarding alcohol consumption from the 2007 survey. Methods: A multistage sampling scheme was used. Provinces, districts, sub-districts, villages and households were randomly selected in sequence. All residents aged 12–65 years who had lived in their current household for >3 months were included. Altogether, 11,348 households and 26,633 respondents from 29 provinces were selected. A structured interview questionnaire, including information on pattern of alcohol consumption, Alcohol Use Disorder Identification Test (AUDIT) and consequences of drinking, was used. Results: Of Thais aged 12–65 years, 63% were abstainers (men—40.9% and women—81.5%). The prevalence of current drinkers (defined as individuals who drank at least 10 g of alcohol in 12 months before the survey) was 28.6% (men—48.4% and women—12.7%). Based on the AUDIT score, 6.7% of the Thai population could be classified as hazardous drinkers, 0.9% as harmful drinkers and 0.6% as probable alcohol dependents. The median drinking intensity was 50.8 g in men and 25.4 g in women. After adjusting for other variables, predictors of being hazardous–harmful or probably dependent drinkers included male gender, age groups of 20–24 and 25–44 years, not married and living in Bangkok. Conclusion: The present study highlights the gender and age differences in drinking patterns and drinking consequences in Thailand. These issues should be taken into consideration when planning preventive measures to reduce alcohol consumption and related problems.

Alcohol Consumption before and after a Significant Reduction of Alcohol Prices in 2004 in Finland: Were the Effects Different across Population Subgroups? 20 Apr 2010

Aims: To examine trends in adult alcohol consumption by age, gender and education from 1982 to 2008 and evaluate the effects that a significant reduction in alcohol prices in 2004 had on alcohol consumption in different population subgroups. Methods: The study population comprised respondents aged 25–64 (n = 79,100) replying to nationally representative annual postal surveys from 1982 to 2008 (average response rate 72%). The main measurements were the prevalence of respondents who had drunk at least eight (men) or five (women) drinks in the previous week (‘moderate to heavy drinkers’) and prevalence of those who weekly (men) or monthly (women) drank six or more drinks on a single occasion (‘heavy episodic drinkers’) (one ‘drink’ containing 11–13 g ethanol). Logistic models were used to test differences across population subgroups in the changes in drinking. Results: Following the reduction of alcohol prices in 2004, drinking increased among men and women aged 45–64. Among men, both moderate to heavy drinking and heavy episodic drinking increased in the lowest educational group. Among women, moderate to heavy drinking increased mostly in the lowest and intermediate educational groups, while the highest increases for heavy episodic drinking were in the intermediate and highest female educational groups. Conclusion: Alcohol consumption increased especially among those aged 45–64 and among lower educated people following the reduction in alcohol prices in 2004 in Finland.

Social Vulnerability of Alcoholics and Patients with Alcohol-Related Dementia: A View from Russia 20 Apr 2010

First Do No Harm: Being a Resilient Doctor in the 21st Century. By Leanne Rowe and Michael Kidd 20 Apr 2010

20 Apr 2010

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