There has been little progress in implementing comprehensive alcohol control strategies in Africa

Alcohol is the most common substance of addiction and a threat not only to health but also to sustainable human development. Consequently, at least a 10% relative reduction in the harmful use of alcohol has been advocated by the World Health Organization (WHO). This perspective describes alcohol use in Africa, strategies to reduce harmful alcohol use, and the ability of African countries to meet this target. Although alcohol consumption in Africa was intermediate compared to other world regions, the total alcohol per capita among alcohol consumers was the second highest (19.5 liters); 19% of Sub-Saharan African men could be classified as binge drinkers. The alcohol industry is the key driver behind the uptake of alcohol use and misuse. The most cost-effective ways to reduce alcohol-related harm is to make alcohol less available and more expensive and to prohibit alcohol advertising. Most African countries have alcohol excise taxes, but these are not adjusted for inflation, meaning that the effectiveness of these taxes will likely decrease with time, leading to greater affordability. The majority of African countries do not have legally binding regulations for alcohol marketing. Alcohol misuse in Africa is not being addressed at a time when available strategies can efficiently and cost-effectively control alcohol-related harm.     

Drinking and its burden in a global perspective: policy considerations and options

AIMS: To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policymakers concerned with reducing rates of alcohol problems. DESIGN/METHODS/SETTING: This summative article draws on the findings of the articles preceding it and of reviews of the literature. FINDINGS AND CONCLUSIONS: Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies.     

Alcohol consumption and non-communicable diseases: epidemiology and policy implications

Aims This paper summarizes the relationships between different patterns of alcohol consumption and various on non‐communicable disease (NCD) outcomes and estimates the percentage of NCD burden that is attributable to alcohol. Methods A narrative review, based on published meta‐analyses of alcohol consumption‐disease relations, together with an examination of the Comparative Risk Assessment estimates applied to the latest available revision of Global Burden of Disease study. Results Alcohol is causally linked (to varying degrees) to eight different cancers, with the risk increasing with the volume consumed. Similarly, alcohol use is related detrimentally to many cardiovascular outcomes, including hypertension, haemorrhagic stroke and atrial fibrillation. For other cardiovascular outcomes the relationship is more complex. Alcohol is furthermore linked to various forms of liver disease (particularly with fatty liver, alcoholic hepatitis and cirrhosis) and pancreatitis. For diabetes the relationship is also complex. Conservatively, of the global NCD‐related burden of deaths, net years of life lost (YLL) and net disability adjusted life years (DALYs), 3.4%, 5.0% and 2.4%, respectively, can be attributed to alcohol consumption, with the burden being particularly high for cancer and liver cirrhosis. This burden is especially pronounced in countries of the former Soviet Union. Conclusions There is a strong link between alcohol and non‐communicable diseases, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes, and these findings support calls by the World Health Organization to implement evidence‐based strategies to reduce harmful use of alcohol.     

Laboratory Models Available to Study Alcohol‐Induced Organ Damage and Immune Variations: Choosing the Appropriate Model

The morbidity and mortality resulting from alcohol‐related diseases globally impose a substantive cost to society. To minimize the financial burden on society and improve the quality of life for individuals suffering from the ill effects of alcohol abuse, substantial research in the alcohol field is focused on understanding the mechanisms by which alcohol‐related diseases develop and progress. Since ethical concerns and inherent difficulties limit the amount of alcohol abuse research that can be performed in humans, most studies are performed in laboratory animals. This article summarizes the various laboratory models of alcohol abuse that are currently available and are used to study the mechanisms by which alcohol abuse induces organ damage and immune defects. The strengths and weaknesses of each of the models are discussed. Integrated into the review are the presentations that were made in the symposium “Methods of Ethanol Application in Alcohol Model—How Long is Long Enough” at the joint 2008 Research Society on Alcoholism (RSA) and International Society for Biomedical Research on Alcoholism (ISBRA) meeting, Washington, DC, emphasizing the importance not only of selecting the most appropriate laboratory alcohol model to address the specific goals of a project but also of ensuring that the findings can be extrapolated to alcohol‐induced diseases in humans.     

Alcohol: No Ordinary Commodity. A summary of the book

This article summarizes the contents of Alcohol: No Ordinary Commodity—Research and public policy ( Babor et al. 2003 ). The first part of the book describes why alcohol is no ordinary commodity, and presents epidemiological data on the global burden of alcohol‐related problems. The second part of the book reviews the scientific evidence for strategies and interventions designed to prevent or minimize alcohol‐related harm: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drinking‐driving countermeasures, regulating alcohol promotion, education and persuasion strategies and treatment services. The final section considers the policymaking process on the local, national and international levels, and provides a synthesis of evidence‐based strategies and interventions from a policy perspective.     

Access to alcohol outlets and harmful alcohol consumption: a multi-level study in Melbourne, Australia

Aims To assess the association between access to off‐premises alcohol outlets and harmful alcohol consumption. Design, setting and participants Multi‐level study of 2334 adults aged 18–75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne. Measurements Alcohol outlet density was defined as the number of outlets within a 1‐km road network of respondents' homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi‐level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short‐term harm at least weekly and monthly; drinking at levels associated with long‐term harm and frequency of consumption. Findings Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short‐term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short‐term harm was when there were eight or more outlets (short‐term harm weekly: OR 2.36, 95% CI 1.22–4.54 and short‐term harm monthly: OR 1.80, 95% CI 1.07–3.04). We found no evidence to support an association between proximity and harmful alcohol consumption. Conclusions The number of off‐premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off‐premises alcohol outlets could reduce levels of harmful alcohol consumption.     

The dimensionality of alcohol use disorders and alcohol consumption in a cross‐national perspective

Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross‐sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM‐IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non‐injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995–2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear‐cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM‐IV criteria tap people in the middle–upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM‐IV diagnostic criteria to help tap the middle–lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM‐IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.     

Alcohol Use Disorders in ICD‐11: Past,Present, and Future

The Eleventh Revision of the International Classification of Diseases (ICD‐11) was formally published in May 2019. Alcohol use disorders form a key part of the section of Disorders due to Substance Use and Addictive Behaviours. This review describes and discusses the alcohol diagnoses within this section of ICD‐11, including Alcohol Dependence, Harmful Pattern of Use of Alcohol, and entities such as Alcohol Intoxication, Alcohol Withdrawal, and several alcohol‐induced mental disorders, and briefly covers Hazardous Alcohol Use, which is listed separately as a health risk factor. We summarize the historical background to the development of these diagnoses, including work within the World Health Organization since the 1970s, and the corresponding diagnoses in the current ICD‐10. The process by which ICD‐11 diagnoses have been made is described and may be summarized as a conceptual–pragmatic–confirmatory one. The available empirical data supporting the ICD‐11 diagnoses are presented, particularly in relation to the diagnostic guidelines for Alcohol Dependence. Comparison is made with the corresponding diagnoses in ICD‐10 and their nearest counterparts in the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders. Field testing of the ICD‐11 diagnoses is currently in progress. A plea is made for matching of diagnoses, diagnostic guidelines/criteria, and the assessment tools intended to capture these diagnoses.     

Alcohol: No Ordinary Commodity – a summary of the second edition

This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high‐, middle‐ and low‐income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol‐related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink‐driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy‐making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost‐effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink‐driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.     

Alcohol Use by Adolescents in Disrupted Families

Alcohol use increases among adults in response to marital disruption and divorce, but data that are available regarding adolescent alcohol use are inconsistent in the light of whether or not families are intact. To explore this question we obtained measures of frequency and quantity of alcohol use from 2595 junior and senior high school students, together with information about family intactness and parental alcohol use. Adolescents in single and stepparent families reported more alcohol use than adolescents from intact families, for both frequency and quantity of use. This was the case for boys and for girls, as well as for junior high school and for senior high school students. Parents in nonintact families also were reported to be using more alcohol than parents in intact families. Adolescent alcohol use was significantly correlated with parental alcohol use. After adjusting adolescent alcohol use for parental alcohol use as a covariate, the finding of greater alcohol use by adolescents in non-intact families remained.     

Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge,Implications, and Future Directions

Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV‐related comorbidities. We find that interventions to modify drinking and improve HIV‐related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV‐relevant outcomes. This should include studies regarding whether state‐of‐the‐art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self‐report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol‐related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90‐90‐90 goals for engagement in the HIV treatment cascade.     

Alcohol use in the elderly: beyond the CAGE. Part 2: Screening instruments and treatment strategies

Recognition of the prevalence of alcohol problems in older patients has led researchers to develop and standardize screening instruments specifically intended for use in the elderly. While the CAGE questionnaire is the most commonly used screening instrument for alcohol use disorders, its usefulness in the geriatric patient has been questioned. Other tools, such as the Alcohol Use Disorders Identification Test (AUDIT), Michigan Alcohol Screening Test-Geriatric Version (MAST-G), and the Alcohol-Related Problems Survey (ARPS) may have additional use in this population. Brief interventions have been shown to be effective in producing sustained abstinence or reducing levels of consumption, thereby decreasing hazardous and harmful drinking. Clinicians may identify specific changes in the medical management of the individual that will reduce risk regardless of drinking behavior.     

Intoxication and hazardous use of alcohol: results from the 1992 Finnish Drinking Habits Study

The harmful or risky use of alcohol among the Finnish population is studied on the basis of data gathered in a national survey. Harms are examined in relation to different styles of drinking, and they are measured using both the Alcohol Use Disorders Identification Test (AUDIT) and the 1992 Drinking Habits Study of the Finnish Foundation for Alcohol Studies. Using an alcohol score of 11 as the cut-off point, 22% of men and 5% of women can be classified as risky drinkers. Young age and family relations are related positively to the prevalence of risky drinking. High scores in the youngest age group (15–19 years) are related to the intoxication-seeking drinking style. Those who drink often and large amounts on individual occasions experience the most harm related to drinking. However, those who drink seldom but more than seven units on a single occasion also experience harmful consequences fairly often and, thus can have high AUDIT scores. Significant others commonly criticize or give advice to the hazardous drinker. Doctors or employers had paid less attention to the intoxication seeking or heavy drinking than the police or the significant others.     

Promoting behavior change from alcohol use through mobile technology: the future of ecological momentary assessment

Background:  Interactive and mobile technologies (i.e., smartphones such as Blackberries, iPhones, and palm‐top computers) show promise as an efficacious and cost‐effective means of communicating health‐behavior risks, improving public health outcomes, and accelerating behavior change. The present study was conducted as a “needs assessment” to examine the current available mobile smartphone applications (e.g., apps) that utilize principles of ecological momentary assessment (EMA)—daily self‐monitoring or near real‐time self‐assessment of alcohol‐use behavior—to promote positive behavior change, alcohol harm reduction, psycho‐education about alcohol use, or abstinence from alcohol. Methods:  Data were collected and analyzed from iTunes for Apple iPhone^©. An inventory assessed the number of available apps that directly addressed alcohol use and consumption, alcohol treatment, or recovery, and whether these apps incorporated empirically based components of alcohol treatment. Results:  Findings showed that few apps addressed alcohol‐use behavior change or recovery. Aside from tracking drinking consumption, a minority utilized empirically based components of alcohol treatment. Some apps claimed they could serve as an intervention; however, no empirical evidence was provided. Conclusions:  More studies are needed to examine the efficacy of mobile technology in alcohol intervention studies. The large gap between availability of mobile apps and their use in alcohol treatment programs indicates several important future directions for research.     

Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002

AIMS: To describe the volume of alcohol consumption and patterns of drinking in the World Health Organization (WHO) European regions in 2002 and to estimate quantitatively the burden of disease attributable to alcohol in that year. METHODS: Secondary data analysis. Exposure data were taken from the WHO Comparative Risk Assessment, outcome data from the WHO Measurement and Health Information department, and used to derive three outcome measures: deaths, years of life lost (YLL) and disability adjusted life years (DALY) for 2002. All calculations were conducted according to age, sex and region. RESULTS: Alcohol consumption in the WHO regions for Europe was high, with 12.1 litres pure alcohol per capita, on average more than 100% above the global consumption. Alcohol consumption caused a considerable disease burden: 6.1% of all the deaths, 12.3% of all YLL and 10.7% of all DALY in all European regions in 2002 could be attributed to this exposure. Intentional and unintentional injuries accounted for almost 50% of all alcohol-attributable deaths and almost 44% of alcohol-attributable disease burden. Young people and men were affected the most. Geographically, the most eastern region around Russia had the highest alcohol-attributable disease burden. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-attributable disease in the European regions. Given the epidemiological structure of the burden, injury prevention, including but not restricted to the prevention of traffic injuries, and specific prevention for young people should play the most important role in a comprehensive plan to reduce alcohol-attributable burden.     

Phosphatidylethanol and Alcohol Consumption in Reproductive Age Women

Background: Fetal alcohol disorders are preventable, but self‐reported alcohol consumption can be misleading and impede effective treatment. Biomarkers represent an alternative method for assessing alcohol use, and this study evaluated the relationship between blood phosphatidylethanol (PEth) and alcohol use in a sample of reproductive age women. Methods: Alcohol use was estimated by validated self‐report methods in 80 nonpregnant women ages 18 to 35. PEth was measured by a contracted laboratory using a liquid chromatography‐tandem mass spectrometry assay. Regression methods appropriate for the distribution of PEth were used to define its relationship to alcohol consumption during the prior 2 weeks and explore the effects of drinking patterns on this association. Receiver operating characteristic analysis was used to estimate the sensitivity of PEth for various drinking levels at 95% specific cutoffs. Results: PEth had a positive linear association with grams of alcohol consumed (p < 0.001), and was detectable in 93% of subjects consuming an average of 2 or more drinks per day. The relationship between total alcohol consumption and PEth may be stronger in women with recent heavy drinking days. The relationship between drinking and PEth varied considerably between individuals, and sensitivity for a certain amount of drinking was low at a highly specific cutoff concentration. Conclusions: PEth is a highly sensitive indicator of moderate and heavy alcohol consumption in reproductive age women and may complement the use of self‐report alcohol screens when additional objective markers of alcohol use are desirable. However, choosing a highly valid cutoff concentration for PEth to differentiate various levels of alcohol consumption may not be feasible.     

Early results from a school alcohol harm minimization study: the School Health and Alcohol Harm Reduction Project

Aims. The School Health and Alcohol Harm Reduction Project aims to reduce alcohol‐related harm by enhancing students' abilities to identify and deal with high‐risk drinking situations particularly likely to be encountered by young people. Design. The SHAHRP study has adopted a quasi‐experimental research design, incorporating intervention and control groups and measuring change over a 3‐year period. Setting. The study is set in metropolitan, government secondary schools (13‐17‐year‐olds) in Perth, Western Australia. The 14 schools involved in the SHAHRP study represent approximately 23% of government secondary schools in the Perth metropolitan area. Participants. The sample was selected using cluster sampling, with stratification by socio‐economic area, and involves over 2300 intervention and control students from junior secondary schools. Seventy‐three per cent (73.7%) of students completed surveys at both baseline and first follow‐up . Intervention. The intervention incorporated evidence‐based approaches to enhance potential for behaviour change in the target population. The intervention is a curriculum‐based programmeme with an explicit harm minimization goal and will be conducted in two phases over a 2‐year period. Measures and findings. The early results of the study demonstrate initial knowledge and attitude change, predicted by the students' involvement in the intervention. A surprising impact of the first phase of SHAHRP was the significant difference in alcohol consumption and harms between control and intervention groups, with the SHAHRP group demonstrating a significantly lower increase in alcohol consumption than the control group. Students who were supervised drinkers at baseline and who received the SHAHRP intervention were overwhelmingly represented in the change results. Conclusions. Results from phase one of the SHAHRP study suggest that classroom‐based alcohol education programmemes can reduce harm, particularly in students who are supervised drinkers prior to the intervention.     

Twenty-one-year trends and correlates of pressure to change drinking

Background: The vast majority of individuals with alcohol problems in the United States and elsewhere do not seek help. One policy response has been to encourage institutions such as criminal justice and social welfare systems to mandate treatment for individuals with alcohol problems (Addiction, 1997; 92 :1133). However, informal pressures to drink less from family and friends are far more common than institutional pressures mandating treatment (Addiction, 1996; 91 :643). The prevalence and correlates of these informal pressures have been minimally studied. Methods: This analysis used data from 5 Alcohol Research Group National Alcohol Surveys (NAS) collected at approximately 5‐year intervals over a 21‐year period (1984 to 2005, pooled N = 16,241) to describe the patterns of pressure that drinkers received during the past year from spouse, family, friends, physicians, police, and the workplace. Results: The overall trend of pressure combining all 6 sources across all 5 NAS data sets indicated a decline. Frequent heavy drinking and alcohol‐related harms also declined, and both were strong predictors of receiving pressure. Trends among different sources varied. In multivariate regression models, pressure from friends showed an increase. Pressure from spouse and family showed a relatively flat trajectory, with the exception of a spike in pressure from family in 1990. Conclusions: The trajectory of decreasing of pressure over time is most likely the result of decreases in heavy drinking and alcohol‐related harm. Pressure was generally targeted toward higher risk drinkers, such as heavy drinkers and those reporting alcohol‐related harm. However, demographic findings suggest that the social context of drinking might also be a determinant of receiving pressure. Additional studies should identify when pressure is associated with decreased drinking and increased help seeking.     

Internet‐based prevention for alcohol and cannabis use: final results of the Climate Schools course

Aims To establish the long‐term efficacy of a universal internet‐based alcohol and cannabis prevention programme in schools. Methods A cluster‐randomized controlled trial was conducted to assess the effectiveness of the Climate Schools: Alcohol and Cannabis Course. The evidence‐based course, aimed at reducing alcohol and cannabis use, is facilitated by the internet and consists of 12 novel and curriculum consistent lessons delivered over 6 months. Participants A total of 764 year 8 students (13 years) from 10 Australian secondary schools were allocated randomly to the internet‐based prevention programme (n = 397, five schools), or to their usual health classes (n = 367, five schools). Measures Participants were assessed at baseline, immediately post, and 6 and 12 months following completion of the intervention, on measures of alcohol and cannabis knowledge, attitudes, use and related harms. Results This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12‐month follow‐up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol‐ and cannabis‐related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools. Conclusions Internet‐based prevention programs for school‐age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.     

Effects of prazosin, an α1-adrenergic receptor antagonist, on the seeking and intake of alcohol and sucrose in alcohol-preferring (P) rats

Background: Previous studies show that prazosin, an α₁‐adrenergic receptor antagonist, decreases alcohol drinking in animal models of alcohol use and dependence [Rasmussen et al. (2009) Alcohol Clin Exp Res 3:264–272; Walker et al. (2008) Alcohol 42:91–97] and in alcohol‐dependent men [Simpson et al. (2009) Alcohol Clin Exp Res 33:255–263]. This study extended these findings by using a paradigm that allows for separate assessment of prazosin on motivation to seek versus consume alcohol or sucrose in selectively bred rats. Methods: Alcohol‐preferring (P) rats were trained to complete an operant response that resulted in access to either 2% sucrose or 10% alcohol. A 4‐week Seeking Test Phase examined responding in single, weekly extinction sessions when no reinforcer could be obtained. A 4‐week Drinking Test Phase consisted of rats lever‐pressing to “pay” a specified amount up front to gain access to unlimited alcohol (or sucrose) for a 20‐minute period. On Seeking and Drinking test days, prazosin (0.0, 0.5, 1.0, and 1.5 mg/kg) was administered intraperitoneally 30 minutes prior to behavioral sessions. Results: Rats were self‐administering an average of 0.9 (±0.09) g/kg alcohol on vehicle test day and had pharmacologically relevant blood ethanol concentrations. Prazosin significantly decreased alcohol seeking at all doses tested. The highest dose of prazosin also increased the latency to first response for alcohol and decreased alcohol intake. While sucrose‐seeking and intake were similarly affected by prazosin, the high dose of prazosin did not increase response latency. Conclusions: These findings are consistent with and extend previous research and suggest that prazosin decreases motivation to initiate and engage in alcohol consumption. The specificity of prazosin in attenuating the initiation of alcohol‐ but not sucrose‐seeking suggests that this effect is not because of prazosin‐induced motor‐impairment or malaise. Together with previous findings, these data suggest that prazosin may be an effective pharmacotherapy, with specific application in people that drink excessively or have a genetic predisposition to alcohol abuse.