Economic theory and evidence on smoking behavior of adults

Aims To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework. Methods A systematic review and appraisal of important theoretical and empirical economic studies on smoking. Results There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk‐tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short‐term rates are higher than long‐term rates for both smokers and non‐smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking. Conclusions Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.     

Anticipatory Socialization for Retirement: A Multilevel Dyadic Model

Role theory, widely used to examine human behavior, has often been used to describe the transition from work to retirement. Anticipatory socialization, a role theory concept, describes the process that occurs prior to role transitions and assists in that transition by helping individuals learn the norms for the new role. However, not all workers engage in retirement planning. Lack of retirement planning is of concern because those individuals who do not plan for major life transitions tend to be less successful in adjusting to role changes. Data from the Health and Retirement Study were used; selection criteria required participants to be age 45 or older, working full- or part-time, and have complete data for the study variables. Multilevel modeling results of dyadic data from the Health and Retirement Study (N?=?1,028 dual-earner couples) indicate that older age, being White, higher income, greater retirement wealth, and looking forward to retirement predicted greater anticipatory socialization (i.e., thinking about and discussing retirement) by both husbands and wives. For wives only, having a health problem limiting work, higher spouse occupational status, and having a spouse who was looking forward to retirement predicted more anticipatory socialization. For husbands only, higher education, higher depressive symptomatology, and lower occupational status predicted more anticipatory socialization. This study found evidence of spousal congruence, with husbands, on average, engaging in more anticipatory socialization than wives. These findings identify couples that could most benefit from targeted efforts to increase anticipatory socialization, which predicts better retirement adjustment and satisfaction.     

Cortical thickness, surface area, and volume of the brain reward system in alcohol dependence: relationships to relapse and extended abstinence

Background: At least 60% of those treated for an alcohol use disorder will relapse. Empirical study of the integrity of the brain reward system (BRS) is critical to understanding the mechanisms of relapse as this collection of circuits is implicated in the development and maintenance of all forms of addictive disorders. This study compared thickness, surface area, and volume in neocortical components of the BRS among nonsmoking light‐drinking controls (controls), individuals who remained abstinent and those who relapsed after treatment. Methods: Seventy‐five treatment‐seeking alcohol‐dependent individuals (abstinent for 7 ± 3 days) and 43 controls completed 1.5T proton magnetic resonance imaging studies. Parcellated morphological data were obtained for following bilateral components of the BRS: rostral and caudal anterior cingulate cortex, insula, medial and lateral orbitofrontal cortex (OFC), rostral and caudal middle and superior frontal gyri, amygdala and hippocampus as well as for 26 other bilateral neocortical regions. Alcohol‐dependent participants were followed over 12‐months after baseline study and were classified as abstainers (no alcohol consumption; n = 24) and relapsers (any alcohol consumption; n = 51) at follow‐up. Results: Relapsers and abstainers demonstrated lower cortical thickness in the vast majority of BRS regions as well as lower global thickness compared to controls. Relapsers had lower total BRS surface area than both controls and abstainers, but abstainers were not significantly different from controls on any surface area measure. Relapsers demonstrated lower volumes than controls in the majority of regions, while abstainers showed lower volumes than controls in the superior frontal gyrus, insula, amygdala, and hippocampus, bilaterally. Relapsers exhibited smaller volumes than abstainers in the right rostral middle and caudal middle frontal gyri and the lateral OFC, bilaterally. In relapsers, lower baseline volumes and surface areas in multiple regions were associated with a greater magnitude of post‐treatment alcohol consumption. Conclusions: Results suggest relapsers demonstrated morphological abnormalities in regions involved in the “top down” regulation/modulation of internal drive states, emotions, reward processing, and behavior, which may impart increased risk for the relapse/remit cycle that afflicts many with an alcohol use disorder. Results also highlight the importance of examining both cortical thickness and surface area to better understand the nature of regional volume loss frequently observed in alcohol use disorders. Results from this report are consistent with previous research implicating plastic neurobiological changes in the BRS in the maintenance of addictive disorders.     

Factor Structure and Item Analysis of the Yale Food Addiction Scale in Obese Candidates for Bariatric Surgery

Converging research suggests phenomenological and neurobiological similarities between excessive food consumption and addictive behaviour in substance dependence. Recently, the Yale Food Addiction Scale (YFAS) has been proposed for the assessment of addictive eating behaviour. The German version of the YFAS was administered to obese individuals seeking bariatric surgery (N = 96). Factor structure, internal consistency, and item statistics were analysed. Forty participants (41.70%) received a food addiction diagnosis. The one‐factorial structure of the YFAS, which has been found in non‐clinical samples, could be confirmed. All but three items had factor loadings >.50. Internal consistency was α = .82. Item analysis revealed that items related to unsuccessful attempts to cut down and consumption despite physical and emotional problems were endorsed by the majority of participants. Findings support the use of the YFAS in clinical populations, while applicability of some items differs between clinical and non‐clinical samples. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Improving work-life balance among administrative officers in Catholic primary schools: Assessing the effect of a Christian religious rational emotive behavior therapy

Objective:Work-life balance (WLB) is an essential precursor of workers’ mental health. The theory of rational emotive behaviour therapy proposes that an imbalance in work and family life may result from people''s dysfunctional perceptions of their work and other aspects of their personal life. Also, the constructive philosophies of rational emotive behavior therapy are said to be congruent with most religious belief systems of Christian clients. Therefore, our research examined the efficacy of Christian religious rational emotive behaviour therapy (CRREBT) on WLB among administrative officers in Catholic primary schools.Methods:This is a group randomized trial involving 162 administrative officers from Catholic primary schools in Southeast Nigeria. The treatment process involved an 8-session CRREBT programme.Results:The scores for WLB of the administrative officers enrolled in the CRREBT programme were significantly improved compared to those in the control group at the end of the study. At the follow-up phase, the CRREBT programme proved to be effective over a 3-month period.Conclusion:CRREBT is an effective therapeutic strategy for managing WLB among Catholic school administrative officers.     

Evaluating a cognitive model of ALDH2 and drinking behavior

Background: Despite evidence for genetic influences on alcohol use and alcohol‐related cognitions, genetic factors and endophenotypes are rarely incorporated in cognitive models of drinking behavior. This study evaluated a model of ALDH2 and drinking behavior stipulating cognitive factors and alcohol sensitivity as accounting for genetic influences on drinking outcomes. Methods: Participants were Asian‐American young adults (n = 171) who completed measures of alcohol cognitions (drinking motives, drinking refusal self‐efficacy, and alcohol expectancies), alcohol sensitivity, drinking behavior, and alcohol‐related problems as part of a prospective study. Structural equation modeling (SEM) evaluated a model of drinking behavior that stipulated indirect effects of ALDH2 on drinking outcomes through cognitive variables and alcohol sensitivity. Results: The full model provided an adequate fit to the observed data, with the measurement model explaining 63% of the variance in baseline heavy drinking and 50% of the variance in alcohol‐related problems at follow‐up. Associations of ALDH2 with cognitive factors and alcohol sensitivity were significant, whereas the association of ALDH2 with drinking was not significant with these factors included in the model. Mediation tests indicated significant indirect effects of ALDH2 through drinking motives, drinking refusal self‐efficacy, and alcohol sensitivity. Conclusions: Results are consistent with the perspective that genetic influences on drinking behavior can be partly explained by learning mechanisms and implicate cognitive factors as important for characterizing associations of ALDH2 with drinking.     

Rational thoughts in neural codes

Complex behaviors are often driven by an internal model, which integrates sensory information over time and facilitates long-term planning to reach subjective goals. A fundamental challenge in neuroscience is, How can we use behavior and neural activity to understand this internal model and its dynamic latent variables? Here we interpret behavioral data by assuming an agent behaves rationally—that is, it takes actions that optimize its subjective reward according to its understanding of the task and its relevant causal variables. We apply a method, inverse rational control (IRC), to learn an agent’s internal model and reward function by maximizing the likelihood of its measured sensory observations and actions. This thereby extracts rational and interpretable thoughts of the agent from its behavior. We also provide a framework for interpreting encoding, recoding, and decoding of neural data in light of this rational model for behavior. When applied to behavioral and neural data from simulated agents performing suboptimally on a naturalistic foraging task, this method successfully recovers their internal model and reward function, as well as the Markovian computational dynamics within the neural manifold that represent the task. This work lays a foundation for discovering how the brain represents and computes with dynamic latent variables.     

Assessing causal relationships using genetic proxies for exposures: an introduction to Mendelian randomization

Background and aims

Studying the consequences of addictive behaviours is challenging, with understanding causal relationships from observational data being particularly difficult. For example, people who smoke or drink excessively are often systematically different from those who do not, are less likely to participate in research and may misreport their behaviours when they do. Furthermore, the direction of causation between an addictive behaviour and outcome may be unclear. Mendelian randomization (MR) offers potential solutions to these problems.

Methods

We describe MR's principles and the criteria under which it is valid. We identify challenges and potential solutions in its application (illustrated using two applied examples) and describe methodological extensions in its application.

Results

MR is subject to certain assumptions, and requires the availability of appropriate genetic data, large sample sizes and careful design and conduct. However, it has already been applied successfully to the addiction literature. The relationship between alcohol consumption (proxied by a variant in the ADH1B gene) and cardiovascular risk has been investigated, finding that alcohol consumption increases risk, with no evidence of a cardioprotective effect at moderate consumption levels. In addition, heaviness of smoking (proxied by a variant in the CHRNA5‐A3‐B4 gene cluster) and risk of depression and schizophrenia have been investigated, with no evidence of a causal effect of smoking on depression but some evidence of a causal effect on schizophrenia.

Conclusions

Mendelian randomization analyses are already producing robust evidence for addiction‐related practice and policy. As genetic variants associated with addictive behaviours are identified, the potential for Mendelian randomization analyses will grow. Methodological developments are also increasing its applicability.     

Sexual Addictions

The potential adverse consequences, personal distress, shame and guilt presented by patients who suffer from sexual addiction require a more in-depth understanding of the phenomenology and psychobiology of this disorder. Methods: A bibliographic review was conducted using MEDLINE and EBSCO databases with the following keywords: “sexual addiction,” “hypersexuality,” “compulsive sexual behavior,” “behavioural addiction,” “treatment,” and “addiction.” Results: Several conceptualizations of excessive nonparaphilic sexual disorder have been proposed based on the models of, respectively, obsessive compulsive disorder, impulse control disorder, out of control excessive sexual disorder, and addictive disorder. Despite the lack of robust scientific data, a number of clinical elements, such as the frequent preoccupation with this type of behavior, the time spent in sexual activities, the continuation of this behavior despite its negative consequences, the repeated and unsuccessful efforts made to reduce the behavior, are in favor of an addictive disorder. In addition there is a high comorbidity between excessive sexual behavior and other addictive behaviors. Conclusion: The phenomenology of excessive nonpara- philic sexual disorder favors its conceptualization as an addictive behavior, rather than an obsessive-compulsive, or an impulse con- trol disorder. Moreover, the criteria that are quite close to those of addictive disorders were recently proposed for the future DSM-V in order to improve the characterization of this condition. Finally, controlled studies are warranted in order to establish clear guidelines for treatment of sexual addiction.     

An Investigation of Goodman's Addictive Disorder Criteria in Eating Disorders

The aim of this study was to examine how far Goodman's addictive disorder criteria were met by individuals with eating disorders according to subtypes. The study provided a cross‐sectional comparison among three samples of eating disorders [restricting anorexia nervosa (R‐AN), N = 68; purging anorexia nervosa (P‐AN), N = 42; and bulimia nervosa (BN), N = 66], a sample of substance‐related disorders (SRDs, N = 48) and a sample of matched controls (N = 201). Diagnosis of addictive disorder was made following Goodman's criteria. Addictive personality traits were assessed with the Addiction Potential Scale of the Minnesota Multiphasic Personality Inventory—2 and with the Zuckerman's Sensation Seeking Scale. Results showed that individuals with BN met Goodman's addictive disorder criteria in the same proportion as drug‐addicted individuals (65% vs 60%, p = NS). They both showed higher rates than R‐AN individuals (35%; R‐AN versus BN: F = 11.9, p < 0.001 and R‐AN versus SRD: F = 7.16, p < 0.01). Although BN and SRD showed higher rates of addictive disorders compared with P‐AN, differences were not significant. Scores on the Sensation Seeking and on the Addictive Potential scales paralleled the distribution of addictive disorders, with individuals with BN and with P‐AN showing higher levels than individuals with R‐AN. Results showed that a subgroup of individuals with an eating disorder experiences their disorder as an addiction and may deserve specific therapeutic attention. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Age- and sex-dependent effects of footshock stress on subsequent alcohol drinking and acoustic startle behavior in mice selectively bred for high-alcohol preference

Background: Exposure to stress during adolescence is known to be a risk factor for alcohol‐use and anxiety disorders. This study examined the effects of footshock stress during adolescence on subsequent alcohol drinking in male and female mice selectively bred for high‐alcohol preference (HAP1 lines). Acoustic startle responses and prepulse inhibition (PPI) were also assessed in the absence of, and immediately following, subsequent footshock stress exposures to determine whether a prior history of footshock stress during adolescence would produce enduring effects on anxiety‐related behavior and sensorimotor gating. Methods: Alcohol‐naïve, adolescent (male, n = 27; female, n = 23) and adult (male, n = 30; female, n = 30) HAP1 mice were randomly assigned to a stress or no stress group. The study consisted of 5 phases: (1) 10 consecutive days of exposure to a 30‐minute footshock session, (2) 1 startle test, (3) one 30‐minute footshock session immediately followed by 1 startle test, (4) 30 days of free‐choice alcohol consumption, and (5) one 30‐minute footshock session immediately followed by 1 startle test. Results: Footshock stress exposure during adolescence, but not adulthood, robustly increased alcohol drinking behavior in both male and female HAP1 mice. Before alcohol drinking, females in both the adolescent and adult stress groups showed greater startle in phases 2 and 3; whereas males in the adolescent stress group showed greater startle only in phase 3. After alcohol drinking, in phase 5, enhanced startle was no longer apparent in any stress group. Males in the adult stress group showed reduced startle in phases 2 and 5. PPI was generally unchanged, except that males in the adolescent stress group showed increased PPI in phase 3 and females in the adolescent stress group showed decreased PPI in phase 5. Conclusions: Adolescent HAP1 mice appear to be more vulnerable to the effects of footshock stress than adult mice, as manifested by increased alcohol drinking and anxiety‐related behavior in adulthood. These results in mice suggest that stress exposure during adolescence may increase the risk for developing an alcohol‐use and/or anxiety disorder in individuals with a genetic predisposition toward high alcohol consumption.     

Association between Adverse Life Events and Addictive Behaviors among Male and Female Adolescents

Background : Adverse life events have been associated with gambling and substance use as they can serve as forms of escapism. Involvement in gambling and substance use can also place individuals in adversely stressful situations. Objectives : To explore potential male–female differences in the association between addictive behavior and adverse life events among an urban cohort of adolescents. Method : The study sample comprised of 515 adolescent participants in a randomized prevention trial. With self‐reported data, four addictive behavior groups were created: nonsubstance users and nongamblers, substance users only, gamblers only, and substance users and gamblers. Multinomial logistic regression analyses with interaction terms of sex and adverse life events were conducted. Results : Adverse life events and engaging in at least one addictive behavior were common for both sexes. Substance users and gamblers had more than twice the likelihood of nonsubstance users and nongamblers to experience any event as well as events of various domains (ie, relationship, violence, and instability). Neither relationship nor instability events’ associations with the co‐occurrence of substance use and gambling significantly differed between sexes. Conversely, females exposed to violence events were significantly more likely than similarly exposed males to report the co‐occurrence of substance use and gambling. Conclusion : Findings from the current study prompt future studies to devote more attention to the development of effective programs that teach adaptive coping strategies to adolescents, particularly to females upon exposure to violence. (Am J Addict 2012;21:516–523)     

Improving measurement of injection drug risk behavior using item response theory

Background: Recent research highlights the multiple steps to preparing and injecting drugs and the resultant viral threats faced by drug users. This research suggests that more sensitive measurement of injection drug HIV risk behavior is required. In addition, growing evidence suggests there are gender differences in injection risk behavior. However, the potential for differential item functioning between genders has not been explored. Objectives: To explore item response theory as an improved measurement modeling technique that provides empirically justified scaling of injection risk behavior and to examine for potential gender-based differential item functioning. Methods: Data is used from three studies in the National Institute on Drug Abuse’s Criminal Justice Drug Abuse Treatment Studies. A two-parameter item response theory model was used to scale injection risk behavior and logistic regression was used to examine for differential item functioning. Results: Item fit statistics suggest that item response theory can be used to scale injection risk behavior and these models can provide more sensitive estimates of risk behavior. Additionally, gender-based differential item functioning is present in the current data. Conclusion: Improved measurement of injection risk behavior using item response theory should be encouraged as these models provide increased congruence between construct measurement and the complexity of injection-related HIV risk. Suggestions are made to further improve injection risk behavior measurement. Furthermore, results suggest direct comparisons of composite scores between males and females may be misleading and future work should account for differential item functioning before comparing levels of injection risk behavior.     

Ethanol Attenuates the HFS-Induced, ERK-Mediated LTP in a Dose-Dependent Manner in Rat Striatum

Background: The striatum has been implicated to play a role in the control of voluntary behavior, and striatal synaptic plasticity is involved in instrumental learning. Ethanol is known to alter synaptic plasticity, in turn altering the behavior of human and animals. However, it remains unclear whether the striatum plays a role in the effects of ethanol on the central nervous system. The objective of this investigation was to study the effects of acute perfusion of ethanol on long‐term potentiation (LTP) to elucidate the mechanisms of addictive drugs in the striatum. In addition, we investigated the contribution of intracellular extracellular signal regulated protein kinase (ERK) signaling pathway to corticostriatal LTP induction. Methods: The stimulation evoked population spikes (PS) were recorded from the dorsomedial striatum (DMS) slices of rat using the extracellular recording technique. The LTP in DMS slices was induced by high‐frequency stimulation (HFS). The ERK level of the DMS was assessed with the Western blot technique. Results: U0126, the inhibitor of ERK, eliminated or significantly attenuated the LTP induced by HFS of the PS in the DMS. MK801 and APV, N‐methyl‐d ‐aspartic acid receptor (NMDAR) antagonists, inhibited the induction of striatal LTP, and HFS‐induced ERK activation decreased in the slices treated with MK801 in the DMS. Clinically relevant concentrations of ethanol (22 to 88 mM) dose‐dependently attenuated the HFS‐induced striatal LTP and ERK activation in this brain region. Conclusions: The LTP of the PS in the DMS is, at least partly, mediated by the ERK pathway coupling to NMDARs. Ethanol attenuated the HFS‐induced, ERK‐mediated LTP in a dose‐dependent manner in this brain region. These results indicate that ethanol may change the synaptic plasticity of corticostriatal circuits underlying the learning of goal‐directed instrumental actions, which is mediated by an intracellular ERK signaling pathway associated with NMDARs.     

Attentional bias and addictive behaviour: automaticity in a gambling-specific modified Stroop task

Aims This study examined the relationship between attention and gambling behaviour by measuring the level of Stroop interference towards gambling‐related words in a group of regular poker machine players. Design A 3 × 2 repeated measures experimental design was employed. The type of word presented (neutral, drug or gambling) was the within‐subjects factor and the level of impaired control (high or low) over gambling behaviour was the between‐subjects factor. Participants A sample of poker machine players (n= 60), varying in their frequency of play, were split into two groups based on their level of subjective impaired control over their gambling behaviour (high or low). Measurements A computerized gambling‐specific modified version of the Stroop task was used to assess response latencies. The test comprised three word categories: gambling, drug and neutral. The Scale of Gambling Choices (SGC 1995 ) was used to assess participants' level of impaired control over gambling behaviour. Findings It was found that the participants who had difficulty in controlling their gambling behaviour (the low control group) took significantly longer to name the colour of the words relating to poker machine gambling, whereas those who had good control over their gambling behaviour (the high control group) did not show any significant differences across the three word categories. Conclusions Results support the previous finding that people with a problem behaviour or emotion take longer to colour‐name words relating to the area of their concern. The current study extends previous work that has investigated the role of cognitive distortions and biases in the area of addictive behaviour. The current study confirms McCusker & Gettings's findings, but by avoiding the mental disorder conceptualization facilitates theoretical understanding of addictive behaviour. Implications for past models and theories of the Stroop as well as future research directions are discussed.     

Development of the Modified Yale Food Addiction Scale Version 2.0

The Yale Food Addiction Scale (YFAS) operationalizes indicators of addictive‐like eating, originally based on the Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM‐IV‐TR) criteria for substance‐use disorders. The YFAS has multiple adaptations, including a briefer scale (mYFAS). Recently, the YFAS 2.0 was developed to reflect changes to diagnostic criteria in the DSM‐5. The current study developed a briefer version of the YFAS 2.0 (mYFAS 2.0) using the participant sample from the YFAS 2.0 validation paper (n = 536). Then, in an independent sample recruited from Mechanical Turk, 213 participants completed the mYFAS 2.0, YFAS 2.0, and measures of eating‐related constructs in order to evaluate the psychometric properties of the mYFAS 2.0, relative to the YFAS 2.0. The mYFAS 2.0 and YFAS 2.0 performed similarly on indexes of reliability, convergent validity with related constructs (e.g. weight cycling), discriminant validity with distinct measures (e.g. dietary restraint) and incremental validity evidenced by associations with frequency of binge eating beyond a measure of disinhibited eating. The mYFAS 2.0 may be an appropriate choice for studies prioritizing specificity when assessing for addictive‐like eating or when a briefer measurement of food addiction is needed. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Lmo genes regulate behavioral responses to ethanol in Drosophila melanogaster and the mouse

Background: Previous work from our laboratory demonstrated a role for the Drosophila Lim‐only (dLmo) gene in regulating behavioral responses to cocaine. Herein, we examined whether dLmo influences the flies’ sensitivity to ethanol’s sedating effects. We also investigated whether 1 of the mammalian homologs of dLmo, Lmo3, is involved in behavioral responses to ethanol in mice. Methods: To examine dLmo function in ethanol‐induced sedation, mutant flies with reduced or increased dLmo expression were tested using the loss of righting (LOR) assay. To determine whether mouse Lmo3 regulates behavioral responses to ethanol, we generated transgenic mice expressing a short‐hairpin RNA targeting Lmo3 for RNA interference‐mediated knockdown by lentiviral infection of single cell embryos. Adult founder mice, expressing varying amounts of Lmo3 in the brain, were tested using ethanol loss‐of‐righting‐reflex (LORR) and 2‐bottle choice ethanol consumption assays. Results: We found that in flies, reduced dLmo activity increased sensitivity to ethanol‐induced sedation, whereas increased expression of dLmo led to increased resistance to ethanol‐induced sedation. In mice, reduced levels of Lmo3 were correlated with increased sedation time in the LORR test and decreased ethanol consumption in the 2‐bottle choice protocol. Conclusions: These data describe a novel and conserved role for Lmo genes in flies and mice in behavioral responses to ethanol. These studies also demonstrate the feasibility of rapidly translating findings from invertebrate systems to mammalian models of alcohol abuse by combining RNA interference in transgenic mice and behavioral testing.     

Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Trøndelag Health Study

Aims The aim of this study was to examine the levels of anxiety and depression among individuals consuming low levels of alcohol. Design Prospective and cross‐sectional population‐based study. Setting and participants This study employed data from the Nord‐Trøndelag Health Survey (HUNT‐2, n = 38 930). Measurements Alcohol consumption was measured by self‐report of usual alcohol consumption during a 2‐week period. Low‐level alcohol consumption was defined as self‐reported abstainers and non‐abstainers currently consuming no alcohol. Anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale. Potential explanatory variables included somatic illness and symptoms, health‐related behaviour, socio‐economic status and social activity. In a subsample (n = 20 337), we also looked at the impact of previous heavy drinking among abstainers ('sick‐quitting'). Findings A U‐shaped association between alcohol consumption and the risk of anxiety and depression was found. Abstention was related to increased odds for both case‐level anxiety [1.34, 95% confidence interval (CI) 1.19–1.52] and depression (1.52, 95% CI 1.30–1.77). This association was accounted for partly by adjustments for socio‐economic status, social network, somatic illness, age (depression only), gender (anxiety only) and ‘sick‐quitting’. We also identified significant differences between participants who label themselves as abstainers compared to those who report no usual alcohol consumption, but who do not label themselves as abstainers. Conclusions The risk of case‐level anxiety and depression is elevated in individuals with low alcohol consumption compared to those with moderate consumption. Individuals who label themselves as abstainers are at particularly increased risk. This increased risk cannot fully be explained by somatic illness, social activity or ‘sick‐quitting’.     

Association of pro-ghrelin and GHS-R1A gene polymorphisms and haplotypes with heavy alcohol use and body mass

Background: Ghrelin, an orexigenic peptide, acts on growth hormone secretagogue receptors (GHS‐R1A), expressed in the hypothalamus as well as in important reward nodes such as the ventral tegmental area. Interestingly, ghrelin has been found to activate an important part of the reward systems, i.e., the cholinergic‐dopaminergic reward link. Additionally, the rewarding and neurochemical properties of alcohol are, at least in part, mediated via this reward link. There is comorbidity between alcohol dependence and eating disorders. Thus, plasma levels of ghrelin are altered in patients with addictive behaviors such as alcohol and nicotine dependence and in binge eating disorder. This overlap prompted as to investigate the pro‐ghrelin and GHS‐R1A genes in a haplotype analysis of heavy alcohol‐using individuals. Methods: A total of 417 Spanish individuals (abstainers, moderate, and heavy alcohol drinkers) were investigated in a haplotype analysis of the pro‐ghrelin and GHS‐R1A genes. Tag SNPs were chosen using HapMap data and the Tagger and Haploview softwares. These SNPs were then genotyped using TaqMan Allelic Discrimination. Results: SNP rs2232165 of the GHS‐R1A gene was associated with heavy alcohol consumption and SNP rs2948694 of the same gene as well as haplotypes of both the pro‐ghrelin and the GHS‐R1A genes were associated with body mass in heavy alcohol consuming individuals. Conclusions: The present findings are the first to disclose an association between the pro‐ghrelin and GHS‐R1A genes and heavy alcohol use, further strengthening the role of the ghrelin system in addictive behaviors and brain reward.     

The published research paper: is it an important indicator of successful operational research at programme level?

Is a published research paper an important indicator of successful operational research at programme level in low‐income countries? In academia, publishing in peer‐reviewed scientific journals is highly encouraged and strongly pursued for academic recognition and career progression. In contrast, for those who engage in operational research at programme level, there is often no necessity or reward for publishing the results of research studies; it may even be criticized as being an unnecessary detraction from programme‐related work. We present arguments to support publishing operational research from low‐income countries; we highlight some of the main reasons for failure of publication at programme level and suggest ways forward.