US state alcohol sales compared to survey data, 1993–2006

Aims Assess long‐term trends of the correlation between alcohol sales data and survey data. Design Analyses of state alcohol consumption data from the US Alcohol Epidemiologic Data System based on sales, tax receipts or alcohol shipments. Cross‐sectional, state annual estimates of alcohol‐related measures for adults from the US Behavioral Risk Factor Surveillance System using telephone surveys. Setting United States. Participants State alcohol tax authorities, alcohol vendors, alcohol industry (sales data) and randomly selected adults aged ≥ 18 years 1993–2006 (survey data). Measurements State‐level per capita annual alcohol consumption estimates from sales data. Self‐reported alcohol consumption, current drinking, heavy drinking, binge drinking and alcohol‐impaired driving from surveys. Correlation coefficients were calculated using linear regression models. Findings State survey estimates of consumption accounted for a median of 22% to 32% of state sales data across years. Nevertheless, state consumption estimates from both sources were strongly correlated with annual r‐values ranging from 0.55–0.71. State sales data had moderate‐to‐strong correlations with survey estimates of current drinking, heavy drinking and binge drinking (range of r‐values across years: 0.57–0.65; 0.33–0.70 and 0.45–0.61, respectively), but a weaker correlation with alcohol‐impaired driving (range of r‐values: 0.24–0.56). There were no trends in the magnitude of correlation coefficients. Conclusions Although state surveys substantially underestimated alcohol consumption, the consistency of the strength of the association between sales consumption and survey data for most alcohol measures suggest both data sources continue to provide valuable information. These findings support and extend the distribution of consumption model and single distribution theory, suggesting that both sales and survey data are useful for monitoring population changes in alcohol use.     

Per Capita Alcohol Sales, Heavy Drinker Prevalence and Alcohol Problems in Iowa for 1958-1985

A series of drinking practices surveys spanning an extended period of uninterrupted alcohol sales growth in Iowa revealed that while per capita alcohol sales were doubling, and the prevalence of drinkers increased 27%, heavy drinker prevalence failed to increase, and a majority of seven survey indicators of problem drinking trended up. The findings have implications for the integrity of the distribution of consumption prevention model.     

Effects on criminal violence of different beverage types and private and public drinking

Aim. The purpose of the study is to analyse the relationship between homicide and assault rates on one hand, and various indicators of alcohol consumption on the other. The latter include private and public drinking with a further disaggregation into beverage-specific drinking. Measurements. The data comprise aggregate time series for Sweden during the period 1956-94. The assault rate is measured as the number of police reported assaults (at all degrees of aggravation) per 100 000 inhabitants (15 + ). The homicide rate is measured as the number of homicides (where the victim was at least one year old) per 100 000 inhabitants (15 + ). Private consumption is gauged as retail sales of alcohol, and public consumption as on-premise sales (litres 100% per inhabitant, 15 + ). These two measures are disaggregated further into beverage specific sales (beer, spirits and wine). Findings. According to the findings, there is a statistically significant relationship between the assault rate and a combined measure of on-premise sales of beer and spirits. The estimated relationship corresponds to an attributable fraction of about 40%. The homicide rate is significantly associated with retail sales of spirits; the attributable fraction is estimated at about 50%. Wine sales are not related to any of the two violence indicators. Conclusions. The findings suggest that the assault rate is related to consumption of beer and spirits in bars and restaurants, while the homicide rate is linked to consumption of spirits in private contexts. The findings, notably specific to Sweden during a certain time period, can be interpreted as the outcome of the interplay of a number of factors, including opportunity structure, social control and context of drinking, drinking patterns associated with the different beverage types and characteristics of the drinkers.     

Alcohol consumption and fatal accidents in Canada, 1950-98

Aims To evaluate the effects of changes in aggregate alcohol consumption on overall fatal accidents, motor vehicle accidents, fatal falling accidents and drowning accidents in Canadian provinces after 1950. Design Time‐series analysis of annual mortality rates (15–69 years) in relation to per capita alcohol consumption, utilising the Box–Jenkins technique. All series were differenced to remove long‐term trends. Measurements Gender‐specific and age‐adjusted mortality rates for the age group 15–69 years were calculated on the basis of mortality data for 5‐year age groups, using a standard population. Data on per capita alcohol consumption was converted to consumption per inhabitant 15 years and older. In the analysis of motor vehicle accidents, the number of motor vehicles was used as a control variable. Findings Statistically significant associations between alcohol consumption and overall fatal accident rates were uncovered in all provinces for males, and in all provinces except Ontario for females. For Canada at large, an increase in per capita alcohol consumption of 1 litre was accompanied by an increase in accident mortality of 5.9 among males and 1.9 among females per 100 000 inhabitants. Among males there was a significant association with alcohol for both falling accidents, motor vehicle accident and other accidents, but the association was insignificant for drowning accidents. Among females, the association with falling accidents and other accidents was significant. Conclusion Changes in alcohol consumption have had substantial effects on most of the main types of fatal accidents in Canada during the second half of the 20th century. The size of the association is comparable to the one previously reported from Northern Europe.     

An investigation of the effect of privatization of retail sales of alcohol on consumption and traffic accidents in Alberta, Canada

AIMS: Privatization of the retail sale of alcohol in Alberta took place primarily between the end of the 1980s and the beginning of the 1990s. The aim of this study was to evaluate the effects of this privatization on alcohol sales and on the incidence of fatal motor vehicle traffic accidents in the province. DATA AND METHOD: Interrupted time-series analysis (ARIMA) with a quasi-experimental control area design was used, and all series were differenced to remove long-term trends. Canada, with the exception of Alberta, was the control area. The effects of privatization were measured by means of created privatization variables. In the analyses of the effects of privatization on alcohol sales, the inhabitants' disposable income and alcohol prices were used as control variables. The study period was 1950-2000. When effects on the number of fatal motor vehicle traffic accidents were analysed the number of road motor vehicle registrations was used as a control variable, and the study period was 1950-98. FINDINGS: Privatization had a significant permanent effect on the sale of spirits, but the effect was not large enough to affect total sales. The effect on wine and beer sales was not significant. There was no significant effect on the number of fatal motor vehicle traffic accidents. CONCLUSION: The fact that sales on the wholesale level continued to be monopolized, along with the fact that alcohol sales were never allowed in ordinary grocery stores, may explain the lack of any larger effects of privatization on alcohol sales in Alberta.     

Per capita alcohol consumption and ischemic heart disease mortality in a panel of US states from 1950 to 2002

Aims To estimate the overall impact of alcohol on ischemic heart disease (IHD) mortality in the United States using aggregate‐level models and to consider beverage‐specific effects that may represent more effectively the changes in drinking patterns over time that are related to both harmful and protective impacts of alcohol consumption on IHD. Design Several model specifications are estimated, including state‐specific autoregressive integrated moving average (ARIMA) models and generalized least squares (GLS) panel models on first‐differenced data. Setting US states from 1950 to 2002. Participants US general population. Measurements Per capita alcohol sales and cigarette sales, age‐standardized IHD and cirrhosis mortality rates. Findings Apparent consumption of total alcohol was associated with a significant overall increase of IHD of about 1% mortality per litre of ethanol. Beverage‐specific models found that spirits consumption was significantly positively related to IHD mortality overall, for both genders and in three regions defined by drinking culture (or ‘wetness’), while beer was found to have a significant protective relationship overall and in the wet region. The results for wine also suggest a protective relationship, but only marginally significant effects were found. Cirrhosis mortality rates were consistently positively related to IHD mortality. Combined results from state‐specific ARIMA models including both cigarette sales and cirrhosis rates were generally consistent with the GLS results. Conclusions Population‐level models confirm individual‐level findings of both harmful and protective relationships between alcohol use patterns and ischemic heart disease mortality. However, an overall harmful impact of per capita alcohol consumption on IHD mortality was found.     

The role of alcohol in the Russian mortality crisis

Aims Alcohol is believed to be an important factor behind the sharp rise in mortality during the period 1990–94 in Russia. However, the rise in the standard alcohol consumption proxy does not seem to be sufficient to explain all the increase in mortality. This study adopts a novel approach to exploring the role of the alcohol factor in the increased mortality by investigating whether the mismatch between trends in mortality and recorded alcohol consumption is due to an underestimation of the consumption increase. Design and measurements First, the alcohol effect on the male accident rate was estimated using data for the period 1959–89. Next, the estimated alcohol effect and the observed accident mortality rate for the period 1990–98 were used to backcast alcohol consumption during that period. Thirdly, the backcasted alcohol series was used to predict trajectories in alcohol poisoning mortality, the homicide rate and all‐cause mortality during the period 1990–98. Findings There was a markedly stronger increase in the backcasted consumption proxy than in the standard alcohol consumption proxy during the period 1990–98. There was a substantial gap between the observed mortality rates and the rates predicted from the standard alcohol consumption proxy, whereas the predictions from the backcasted alcohol proxy were much closer to the target. Conclusions Much of the rise in Russian mortality in 1990–94 appears to have been due to the increase in population drinking, but this increase is grossly underestimated by the commonly used consumption proxy combining alcohol sales, estimation of illicit alcohol production and proportion of alcohol‐positive violent deaths.     

Bringing alcohol on campus to raise money: impact on student drinking and drinking problems

AIMS: Universities are striving to raise funds, often attracting spectators by selling alcohol at campus events. This study evaluates the effect of a policy change on student drinking at a large western university that had historically banned alcohol on campus but transitioned to permitting the sale of alcohol in some of its facilities. METHODS: Surveys of student drinking and perceptions of other students' drinking were conducted before, during and after the policy change at the transition university (TU) and compared to similar data from a control university (CU). Surveys of student drinking at on-campus and off-campus venues and observations of alcohol service practices were also conducted. RESULTS: The policy change at the TU was introduced cautiously, and sales to underage drinkers were relatively well controlled. Despite this, student drinking rose initially, then declined after 1 year. Perceptions of the amount of drinking by other students increased slightly, but there was no overall measurable increase in student drinking during the first 3 years of the new policy. CONCLUSIONS: The conservative TU policy-to sell alcohol only at select events and to control sales to minors-may have limited the impact of on-campus alcohol sales on student consumption. Although the study results did not find a stable increase in student drinking, they do not necessarily support the liberalization of campus alcohol policy, because the transition is still 'in progress' and the final outcome has not been evaluated.     

Alcohol-related human losses in Russia in the 1980s and 1990s

ABSTRACT Aims The estimation of alcohol‐related human losses in Russia in the 1980s and 1990s. Design The estimation was made by comparing changes in the total number of deaths and in specific categories, and alcohol consumption in Russia during this time. Setting The anti‐alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol ­consumption in Russia. Findings In the early 1980s, the aggregate number of direct and indirect alcohol‐related life losses was more than 500 000 per annum, or 32% of total deaths. Half of the alcohol‐related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti‐alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100 000 of the population. It is estimated that from 1986 to 1991 the lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti‐alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so‐called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol‐related deaths for 1994 was 751 000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999–2000. Conclusion The results of this study show the enormous scale of alcohol‐related mortality in Russia. It has been revealed that alcohol‐related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia.     

Potential consequences of replacing a retail alcohol monopoly with a private licence system: results from Sweden

Aim To examine the potential effects of replacing the Swedish alcohol retail system with a private licensing system on alcohol consumption and alcohol‐related harm. Design Two possible scenarios were analysed: (1) replacing the current alcohol retail monopoly with private licensed stores that specialize in alcohol sales or (2) making all alcohol available in grocery stores. We utilized a multiplicative model that projected effects of changes in a set of key factors including hours of sale, retail prices, promotion and advertising and outlet density. Next, we estimated the effect of the projected consumption increase on a set of harm indicators. Values for the model parameters were obtained from the research literature. Measurements Measures of alcohol‐related harm included explicitly alcohol‐related mortality, accident mortality, suicide, homicide, assaults, drinking driving and sickness absence. Findings According to the projections, scenario 1 yields a consumption increase of 17% (1.4 litres/capita), which in turn would cause an additional 770 deaths, 8500 assaults, 2700 drinking driving offences and 4.5 million sick days per year. The corresponding figures for scenario 2 are a consumption increase of 37.4% (3.1 litres/capita) leading to an additional annual toll of 2000 deaths, 20 000 assaults, 6600 drinking driving offences and 11.1 million days of sick leave. Conclusions Projections based on the research literature suggest that privatization of the Swedish alcohol retail market would significantly increase alcohol consumption and alcohol‐related harm.     

Effects of Alcohol Taxes on Alcohol‐Related Mortality in Florida: Time‐Series Analyses From 1969 to 2004

Background: Over a hundred studies have established the effects of beverage alcohol taxes and prices on sales and drinking behaviors. Yet, relatively few studies have examined effects of alcohol taxes on alcohol‐related mortality. We evaluated effects of multiple changes in alcohol tax rates in the state of Florida from 1969 to 2004 on disease (not injury) mortality. Methods: A time‐series quasi‐experimental research design was used, including nonalcohol deaths within Florida and other states’ rates of alcohol‐related mortality for comparison. A total of 432 monthly observations of mortality in Florida were examined over the 36‐year period. Analyses included ARIMA, fixed‐effects, and random‐effects models, including a noise model, tax independent variables, and structural covariates. Results: We found significant reductions in mortality related to chronic heavy alcohol consumption following legislatively induced increases in alcohol taxes in Florida. The frequency of deaths (t = ?2.73, p = 0.007) and the rate per population (t = ?2.06, p = 0.04) declined significantly. The elasticity effect estimate is ?0.22 (t = ?1.88, p = 0.06), indicating a 10% increase in tax is associated with a 2.2% decline in deaths. Conclusions: Increased alcohol taxes are associated with significant and sizable reductions in alcohol‐attributable mortality in Florida. Results indicate that 600 to 800 lives per year could be saved if real tax rates were returned to 1983 levels (when the last tax increase occurred). Findings highlight the role of tax policy as an effective means for reducing deaths associated with chronic heavy alcohol use.     

Behavioral traits predicting alcohol drinking in outbred rats: an investigation of anxiety, novelty seeking, and cognitive flexibility

Background: Most adults in Western society consume alcohol regularly without negative consequences. For a small subpopulation, however, drinking can quickly progress to excessive and chronic intake. Given the dangers associated with alcohol abuse, it is critical to identify traits that may place an individual at risk for developing these behaviors. To that end, we used a rat model to determine whether anxiety‐related behaviors, novelty seeking, or cognitive flexibility predict excessive alcohol drinking under both limited and continuous access conditions. Methods: Adult male rats were assessed in a series of behavioral tasks (elevated plus maze [EPM], locomotor activity, and discrimination/reversal learning in a Y‐maze) followed by 6 weeks of daily, 1‐hour access to alcohol in a free‐choice, 2‐bottle paradigm (10% alcohol vs. tap water). Next, subjects were given the opportunity to consume alcohol for 72 hours in drinking chambers that permit separate measures of each drinking bout. Half of the animals experienced a 2‐week deprivation period between the limited and continuous access sessions. Results: Time spent on the open arms of the EPM, but not novelty seeking or discrimination/reversal learning, predicted alcohol consumption during limited, 1‐h/d access sessions to alcohol. Anxiety‐related behavior also predicted the escalation of intake when animals were given 72 hours of continuous access to alcohol. Bout size, but not frequency, was responsible for the increased consumption by high‐anxiety subjects during this period. Finally, intake during limited access sessions predicted intake during continuous access, but only in subjects with low intake during limited access. Conclusions: These findings confirm that preexisting anxiety‐related behavior predicts alcohol intake under several schedules of alcohol access. Moreover, when access is unlimited, the high‐anxiety‐related group exhibited an increase in bout size, but not frequency, of drinking. In addition, we show that modest intake when alcohol is restricted may or may not progress to excessive intake when the drug is freely available.     

Estimating the number of alcohol‐attributable deaths: methodological issues and illustration with French data for 2006

Aims Computing the number of alcohol‐attributable deaths requires a series of hypotheses. Using French data for 2006, the potential biases are reviewed and the sensitivity of estimates to various hypotheses evaluated. Methods Self‐reported alcohol consumption data were derived from large population‐based surveys. The risks of occurrence of diseases associated with alcohol consumption and relative risks for all‐cause mortality were obtained through literature searches. All‐cause and cause‐specific population alcohol‐attributable fractions (PAAFs) were calculated. In order to account for potential under‐reporting, the impact of adjustment on sales data was tested. The 2006 mortality data were restricted to people aged between 15 and 75 years. Results When alcohol consumption distribution was adjusted for sales data, the estimated number of alcohol‐attributable deaths, the sum of the cause‐specific estimates, was 20 255. Without adjustment, the estimate fell to 7158. Using an all‐cause mortality approach, the adjusted number of alcohol‐attributable deaths was 15 950, while the non‐adjusted estimate was a negative number. Other methodological issues, such as computation based on risk estimates for all causes for ‘all countries’ or only ‘European countries’, also influenced the results, but to a lesser extent. Discussion The estimates of the number of alcohol‐attributable deaths varied greatly, depending upon the hypothesis used. The most realistic and evidence‐based estimate seems to be obtained by adjusting the consumption data for national alcohol sales, and by summing the cause‐specific estimates. However, interpretation of the estimates must be cautious in view of their potentially large imprecision.     

Pattern of drinking and fatal injury: a population-based follow-up study of Finnish men

AIM: To find out how the frequency of drinking one to two drinks, three to four drinks and five or more drinks of alcohol per drinking occasion predicts injury mortality in 16 years of follow-up among the Finnish 15-69-year-old male population. DESIGN: Three alcohol surveys conducted in 1969, 1976 and 1984 were pooled and linked with mortality information from the national cause of death register. METHOD: Cox proportional hazard models were used for analysing the survival time data. FINDINGS: Drinking at the level of one to two drinks, regardless of frequency, did not elevate the risk of fatal injury, nor did drinking at the level of three to four drinks. Drinking five or more drinks at a time significantly increased the risk of fatal injury in graded relation, compared with those who never drank at that level. The risk was highest for those who drank five or more drinks at a time at least weekly (RR = 5.78, 95% CI = 2.80-11.94), when adjusted for possible confounders. CONCLUSIONS: We found that besides the total volume of consumption, a drinking pattern that involves drinking occasions when consumption exceeds four drinks of alcohol at a time leads to a significant increase in the risk of fatal injury among Finnish men. The risk is highest among those who have the highest annual number of heavy drinking occasions. The finding does not support the hypothesis that alcohol tolerance would lower the risk of fatal injuries among frequent heavy drinkers.     

Alcohol drinking as a predictor of intensive care and hospital mortality in general surgery: a prospective study

Aims To analyse whether alcohol drinking increases admission to intensive care and in‐hospital mortality in general surgery. Design and participants A prospective cohort study on a consecutive series of 1505 hospitalized patients in a Service of General Surgery of a tertiary hospital. Measurements Drinking pattern was defined by quantity, frequency and volume of drinking. Information on relevant confounders was obtained: smoking, body mass index, nutritional status (measured by serum albumin), cholesterol and its fractions, severity of the underlying disease and all therapeutic measures. Multivariate logistic regression was applied to assess the relationship between drinking and both admission to intensive care and in‐hospital death. Results Twenty‐nine (1.9%) patients died and 33 (2.1%) were admitted to the intensive care unit (ICU). Drinking was heavier in men, patients without antecedents of cancer, with lower preoperative risk assessment scores, number of co‐morbidities and age and higher serum albumin levels. After adjusting for age, severity of underlying disease, smoking and serum albumin, male drinkers of 72+ g/day had an increased risk of being admitted to ICU, the effect being stronger for week‐day drinking (odds ratio, OR = 8.48; 95% confidence interval, CI = 1.68–42.8). A significant association was also seen between week‐day drinking (72+ g/day) and death in men (OR = 7.19, 95% CI = 1.43–36.1). Numbers for women were too small to evaluate. Conclusion Heavy drinking increases admission to intensive care and in‐hospital mortality in hospitalized male patients undergoing general surgery procedures.     

Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies

Aims We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self‐reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing1003 estimates of the tax/price–consumption relationship. Design Studies included analyses of alternative outcome measures, varying subgroups of the population, several statistical models, and using different units of analysis. Multiple estimates were coded from each study, along with numerous study characteristics. Using reported estimates, standard errors, t‐ratios, sample sizes and other statistics, we calculated the partial correlation for the relationship between alcohol price or tax and sales or drinking measures for each major model or subgroup reported within each study. Random‐effects models were used to combine studies for inverse variance weighted overall estimates of the magnitude and significance of the relationship between alcohol tax/price and drinking. Findings Simple means of reported elasticities are ?0.46 for beer, ?0.69 for wine and ?0.80 for spirits. Meta‐analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate‐level r = ?0.17 for beer, ?0.30 for wine, ?0.29 for spirits and ?0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = ?0.28, individual‐level r = ?0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking. Conclusions A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.     

Implementing a reward and reminder underage drinking prevention program in convenience stores near southern california american Indian reservations

Background: Underage drinking is associated with a number of social and public health consequences. Preventing access to alcohol is one approach to reducing underage drinking. Objectives: This study assesses the efficacy of a culturally tailored "reward and reminder" program aimed at reducing convenience store alcohol sales to youth living on or near nine American Indian reservations. Methods: First, tribal council proclamations were sought to support underage drinking prevention, including reward and reminder efforts. Then, decoys (volunteers over 21 years of age but judged to look younger) attempted to purchase alcohol without identification. Clerks who asked for identification were given "rewards" (gift cards and congratulatory letters), whereas clerks who did not were given "reminders" of the law regarding sales to minors. Following an initial baseline of 12 purchase attempts, three repeated reward and reminder visits were made to 13 convenience stores selling alcohol within 10 miles of the reservations (n = 51 total attempts). Results: Five of nine tribal councils passed resolutions in support of the program. The baseline sales rate without requesting ID was 33%. Similarly, 38% of stores in the first reward and reminder visit round failed to request identification. However, in the following two reward and reminder rounds, 0% of the stores failed to request identification. Conclusions: These results indicate that environmental community-level underage drinking prevention strategies to reduce alcohol sales near rural reservations are feasible and can be effective. Scientific Significance: Environmental prevention strategies within reservation communities support integrated supply and demand reduction models for reducing underage drinking.     

Abstinence From Moderate Alcohol Self-Administration Alters Progenitor Cell Proliferation and Differentiation in Multiple Brain Regions of Male and Female P Rats

Background: Acute and chronic ethanol exposure has been found to decrease hippocampal neurogenesis, reduce dendritic differentiation of new neurons, and increase cell death. Interestingly, abstinence from such treatment increases hippocampal neurogenesis and microglial genesis across several brain regions. The goal of the current investigation was to study cellular alterations on neuro‐ and cell‐genesis during abstinence following alcohol self‐administration using alcohol‐preferring rats (P rats). Methods: Male and female P rats were given the choice of drinking 10% alcohol in water or pure water for 7 weeks. Social interaction behavioral assessments were conducted at 5 hours upon removal of alcohol, followed by bromo‐deoxyuridine (BrdU, 150 mg/kg × 1/d × 14 d) injections to label proliferating cells. Animals were then killed 4 weeks later to conduct immunohistochemical and confocal analyses using antibodies against BrdU and other phenotypic markers (NeuN for mature neurons; Iba‐1 for microglia; GFAP for astrocytes; and NG₂ for oligodendrocyte progenitors). Results: Mild alcohol withdrawal anxiety was detected by reduction in social interactions. The number of hippocampal BrdU⁺ cells was increased approximately 50% during alcohol abstinence (26 ± 2.8 in controls vs. 39 ± 4 in alcohol group). BrdU⁺ cells were also increased in the substantia nigra (SN) approximately 65% in the alcohol abstinent group (12 ± 1 in controls vs. 19 ± 1.5 in alcohol group). No gender differences were found. Confocal analyses indicated that approximately 75% of co‐localization of BrdU⁺ cells with NeuN in the hippocampal dentate gyrus (DG) resulting a net increase in neurogenesis in the alcohol abstinent group compared to controls. In cingulum, greater proportion of BrdU⁺ cells were co‐localized with NG₂ in the alcohol abstinent group indicating increased differentiation toward oligodendrocyte progenitors in both genders. However, the phenotype of the BrdU⁺ cells in SN and other brain regions were not identified by NeuN, Iba‐1, GFAP, or NG₂ suggesting that these BrdU⁺ cells probably remain in a nondifferentiated stage. Conclusions: These data indicate that abstinence from moderate alcohol drinking increases hippocampal neurogenesis, cingulate NG₂ differentiation, and SN undifferentiated cell proliferation in both males and females. Such cellular alteration during abstinence could contribute to the spontaneous partial restoration of cognitive deficits upon sobriety.     

Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol--the case of Canada

Aims To analyse post‐war variations in per capita alcohol consumption in relation to gender‐specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non‐alcoholic cirrhosis). Data and method Annual liver cirrhosis mortality rates by 5‐year age groups were converted into gender‐specific and age‐adjusted mortality rates. Outcome measures included total cirrhosis—the conventional measure of liver cirrhosis—alcoholic cirrhosis and non‐alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10‐year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box–Jenkins technique for time‐series analysis was used to estimate the temporal relationship. Findings Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non‐alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time‐series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1‐litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non‐alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol‐related. Conclusions Some well‐established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol‐related deaths tend to be under‐reported in mortality statistics.     

The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland

Aim To compare alcohol purchasing and consumption by ill drinkers in Edinburgh with wider alcohol sales in Scotland. Design Cross‐sectional. Setting Two hospitals in Edinburgh in 2008/09. Participants A total of 377 patients with serious alcohol problems; two‐thirds were in‐patients with medical, surgical or psychiatric problems due to alcohol; one‐third were out‐patients. Measurements Last week's or typical weekly consumption of alcohol: type, brand, units (1 UK unit 8 g ethanol), purchase place and price. Findings Patients consumed mean 197.7 UK units/week. The mean price paid per unit was £0.43 (lowest £0.09/unit) (£1 = 1.6 US$ or 1.2€), which is below the mean unit price, £0.71 paid in Scotland in 2008. Of units consumed, 70.3% were sold at or below £0.40/unit (mid‐range of price models proposed for minimum pricing legislation by the Scottish Government), and 83% at or below £0.50/unit proposed by the Chief Medical Officer of England. The lower the price paid per unit, the more units a patient consumed. A continuous increase in unit price from lower to higher social status, ranked according to the Scottish Index of Multiple Deprivation (based on postcode), was not seen; patients residing in postcodes in the mid‐quintile paid the highest price per unit. Cheapness was quoted commonly as a reason for beverage choice; ciders, especially ‘white’ cider, and vodka were, at off‐sales, cheapest per unit. Stealing alcohol or drinking alcohol substitutes was only very rarely reported. Conclusions Because patients with serious alcohol problems tend to purchase very cheap alcohol, elimination of the cheapest sales by minimum price or other legislation might reduce their consumption. It is unknown whether proposed price legislation in Scotland will encourage patients with serious alcohol problems to start stealing alcohol or drinking substitutes or will reduce the recruitment of new drinkers with serious alcohol problems and produce predicted longer‐term gains in health and social wellbeing.