New formulation metered dose inhaler increases breath alcohol levels.

A new, chlorofluorocarbon-free metered dose inhaler containing salbutamol, with small amounts of ethanol as a co-solvent, has recently been released. We evaluated the effect on breath alcohol levels of two inhalations from this metered dose inhaler. In 10 volunteers, breath alcohol levels rose to 17.9 micrograms 100 ml-1 breath after an inhalation with a good technique, and to 35 micrograms 100 ml-1 breath (the current legal limit for driving in the UK) after a poor inhalation. Breath alcohol levels were reduced by the use of a spacer device, and in all cases fell to near zero after 2 min. In patients who have just used this type of metered dose inhaler, breath alcohol measurements should be defferred for at least 2 min.     

The impact of later trading hours for hotels on levels of impaired driver road crashes and driver breath alcohol levels

AIM: To examine the impact of later trading hours for licensed hotels in Perth, Western Australia on levels of associated impaired driver road crashes and driver breath alcohol levels (BALs). DESIGN: Police data on the "last place of drinking" for impaired drivers involved in road crashes and their corresponding BALs were examined to identify those associated with Perth hotels between 1 July 1990 and 30 June 1997. During this period, 43 (23%) of the 186 hotels meeting study criteria were granted an Extended Trading Permit for 1 a.m. closing (ETP hotels), while the rest continued to close at midnight (non-ETP hotels). Time-series analyses employing multiple linear regressions were applied to determine whether an association existed between the introduction of extended trading and (i) monthly levels of impaired driver road crashes associated with ETP hotels and (ii) driver BALs associated with ETP hotels. Trends associated with non-ETP hotels were included as controls and possible confounders were considered. FINDINGS: After controlling for the trend in crash rates associated with non-ETP hotels and the introduction of mobile police breath testing stations to Perth freeways, a significant increase in monthly crash rates for ETP hotels was found. This relationship was largely accounted for by higher volumes of high-alcohol content beer, wine and spirits purchased by ETP hotels. No relation was found between driver BALs and the introduction of ETPs. CONCLUSIONS: Late trading was associated with increased levels of impaired driver road crashes and alcohol consumption, particularly high-risk alcoholic beverages. Greater numbers of patrons and characteristics specific to clientele of hotels which applied for late trading hours (i.e. younger age, greater propensity to drunk-drive, preference for high-risk beverages) were suggested as having contributed to this increase.     

Influence of subjective intoxication, breath alcohol concentration, and expectancies on the alcohol-aggression relation

BACKGROUND: The purpose of this study was to investigate the influence of subjective intoxication, alcohol-aggression expectancies, and breath alcohol concentration (BrAC) on intoxicated aggression in men and women while controlling for dispositional aggressivity. METHODS: Subjects were 328 (163 men and 165 women) healthy social drinkers between 21 and 35 years of age. Following the consumption of either an alcohol or an active placebo beverage, subjects were tested on a modified version of the Taylor Aggression Paradigm in which mild electric shocks were received from, and administered to, a fictitious opponent during a competitive task. Levels of subjective intoxication and BrAC were measured immediately before subjects began the aggression task. Aggressive behavior was operationalized as the shock intensities administered to the fictitious opponent under conditions of low and high provocation. RESULTS: Subjective intoxication ratings were not related to aggressive behavior for either men or women. Alcohol-aggression expectancies were related to aggression for men, but this effect was rendered nonsignificant when controlling for dispositional aggressivity, which in turn, was significantly related to the dependent variables for both men and women. Finally, BrAC was also related to aggression above and beyond the effects of dispositional aggressivity, yet only for men. CONCLUSIONS: Taken as a whole, this study suggests that intoxicated aggression is primarily the result of alcohol's pharmacological properties in conjunction with an aggressive disposition.     

Self-reported subjective perception of intoxication reflects family history of alcoholism when breath alcohol levels are constant

BACKGROUND: The premise of this study is that the increased familial risk for alcoholism is associated with genetic determinants of the response to alcohol, characterized by sensitivity and adaptation. Following a single administration, sensitivity is the initial response to alcohol, expressed as the change in dependent measures from baseline. Adaptation of dependent measures within a single exposure to alcohol can be expressed as acute tolerance (recovery of dependent measures toward baseline values) or sensitization (movement of dependent measure further away from baseline values). This study tested the hypothesis that family history-positive (FHP) subjects are more sensitive and more adaptive to alcohol compared with family history-negative (FHN) subjects. METHODS: The initial response and development of adaptation to alcohol were assessed by using self-reported subjective perceptions during a breath alcohol concentration (BrAC) clamp of 60 mg%. The Biphasic Alcohol Effects Scale, the Sensation Scale and a visual analog scale of intoxication were acquired at baseline, after the BrAC clamp was established, and after maintenance of the clamp for 105 min. RESULTS: FHP subjects were more sensitive to alcohol compared with FHNs, as evidenced by greater changes in feelings of intoxication when the BrAC clamp was initially achieved. While the clamp was maintained, the FHP subjects adapted to the effects of alcohol and their perceptions of intoxication became indistinguishable from those of the FHN subjects. The FHP subjects had developed acute tolerance to alcohol, whereas the FHN subjects did not. Other self-reported perceptions of alcohol's effects did not distinguish between the groups. CONCLUSIONS: A differential family history of alcoholism was reflected in self-reported subjective perceptions of intoxication when the brain's exposure to a specified concentration of alcohol was held constant (BrAC of 60 mg%). FHP subjects reported greater intoxication after alcohol and subsequently developed acute tolerance to alcohol compared with FHN subjects.     

Serum alanine aminotransferase levels among volunteer blood donors: effect of sex, alcohol intake and obesity.

Serum alanine aminotransferase (ALT) activity and antibody to hepatitis B core antigen (anti-HBc) were proposed as surrogate markers of non-A, non-B (NANB) infection. In this study we analyzed 649 consecutive repeat blood donors to define the possible exclusion rate if both surrogate markers were implemented in our Blood Service, and to assess risk factors associated with elevated ALT levels. One hundred and seven blood donors (16.5%) had slightly elevated ALT levels (higher than the upper reference value, but less than twice this level), but only 15 (2.3%) had a level higher than mean log + 2.25 SD. Seventy-seven (11.8%) resulted anti-HBc positive. Blood donors with elevated ALT levels and those who were anti-HBc positive belonged to different populations, being only 6 (0.9%) positive for both surrogate markers. Only two known donors (0.3%) resulted anti-HCV positive, and each of them was implicated in one of the four post-transfusion hepatitis (PTH) cases observed in 200 recipients of blood from these 649 donors. Both were negative for anti-HBc but one had elevated ALT levels. Male sex, age, alcohol use and obesity resulted all independently and significantly associated with elevated ALT levels. For both alcohol use and body weight we observed a significant linear relationship with serum ALT levels. These findings suggest that in our Region the exclusion of blood donors with ALT levels above the reference value, or those anti-HBc positive, would exclude an unacceptably high rate of blood donors without proven evidence of post-transfusion hepatitis prevention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Liver damage, alcohol use, and diagnosis

This study examined the degree of liver damage, reflected by standard laboratory tests, in a group of male veterans in regard to their self-reported histories and diagnosis of alcoholism. Fifty-two percent of the patients were diagnosed as alcoholic. The correlation between liver damage, judged by a physician reviewing the tests, and diagnosis of alcoholism was r =.33. Although liver damage does not develop in some alcoholics, this minimal correlation suggests the need to look for other nutritional and genetic factors that may interact with alcoholism in development of liver damage.     

Subjective intoxication in response to alcohol challenge: heritability and covariation with personality,breath alcohol level,and drinking history

BACKGROUND: Numerous studies have identified differences in subjective response to alcohol in subjects differentiated by family history of alcoholism. Results suggest that genetic influences on individual variation in subjective response to alcohol may be a mechanism for genetic effects on alcohol problems. However, direct evidence for genetic effects on subjective response to alcohol is very limited. METHODS: In a sample of 99 adult twin pairs, we studied genetic influences on subjective intoxication after alcohol challenge. The twins ingested a standard dose of ethanol (0.70 g/kg for men/0.65 g/kg for women), and two measures of subjective response to alcohol were assessed. RESULTS: Genetic effects on variation in subjective intoxication reported 1 hr after drinking were significant and substantial: heritability was 0.60 for a 22-item scale and 0.48 for a brief 2-item measure. Self-report measures of neuroticism, psychasthenia, hostility, and family problems shared significant genetic covariation with subjective intoxication. Achieved breath alcohol level, rate of change in breath alcohol on the descending limb, and individual drinking history all shared familial variation with subjective intoxication. No significant genetic effects for subjective intoxication were found 2 hr after drinking, but familial influences remained present, and many of the same personality, drinking history, and breath alcohol variables were predictive of intoxication. CONCLUSIONS: Subjective response to alcohol is heritable, and genetic effects on subjective intoxication are partly shared with genetic effects on personality.     

Serum 6-beta-naltrexol levels are related to alcohol responses in heavy drinkers

BACKGROUND: There is strong evidence for the role of the endogenous opioid system in alcohol reinforcement and consumption; however, recent human laboratory studies and clinical trials have reported mixed effects of naltrexone (a nonselective opioid antagonist) on alcohol-related behaviors. This paper reports a secondary data analysis of a human laboratory study that examines the relationship between serum levels of 6-beta-naltrexol, the major, biologically active metabolite of naltrexone, and subjective effects of alcohol. METHODS: The study used a within-subjects design to examine the effects of naltrexone (0, 50, and 100 mg/day) on subjective responses to alcohol (none, moderate, and high dose) in heavy drinkers (n = 23). Each subject received three doses of naltrexone in random order; each naltrexone dose was administered over an 8 day period on an inpatient unit, with a 1 week outpatient washout between doses. After stabilization at each of the naltrexone doses, subjects participated in three alcohol challenge sessions (none, moderate, and high dose) in random order; thus, each subject participated in a total of nine alcohol administration sessions. RESULTS: Doubling the naltrexone dose (50 vs. 100 mg/day) doubled the mean serum 6-beta-naltrexol levels. At each naltrexone dose, there was a 4-fold range in 6-beta-naltrexol levels across subjects. Before alcohol administration, higher 6-beta-naltrexol levels were associated with higher ratings of sedation. After high-dose alcohol administration, higher 6-beta-naltrexol levels were associated with significantly lower ratings of liking and best effects. CONCLUSIONS: These findings provide further evidence of the involvement of the opioid system in the modulation of alcohol effects and suggest that serum 6-beta-naltrexol concentrations may be important in predicting therapeutic response to naltrexone.     

Smoking, alcohol consumption, lipid and lipoprotein levels

The lipid profiles of 1165 French Canadian men (aged 42 to 59 years) were studied and related to drinking and smoking habits. Alcohol consumption and smoking were closely related, smokers consuming twice as much alcohol as non-smokers. When relative body weight, total cholesterol, triglyceride and alcohol consumption were controlled in a covariate analysis, plasma levels of high density lipoprotein (HDL) cholesterol, HDL2 and HDL3 differed significantly between smokers, ex-smokers and nonsmokers. Ex-smokers had higher levels of HDL cholesterol than nonsmokers who had higher levels than smokers. The higher levels of HDL in ex-smokers could be explained by the confounding effects of alcohol intake. Alcohol users had significantly higher levels of HDL cholesterol, HDL2 and HDL3 than nondrinkers. Men who drank the equivalent of more than 3 ounces of absolute alcohol per week had significantly higher levels of HDL cholesterol and HDL3 than those who drank less than 3 ounces or did not drink at all. HDL2 levels were only significantly different between nondrinkers and those who consumed more than 3 ounces per week. These results show that smoking and alcohol have strong but opposing effects on HDL and its subfractions in middle-aged French Canadian men.     

Informed consent, deception, and the use of disguised alcohol questionnaires

In preparation for a physician intervention trial to determine the effectiveness of treatment of alcoholism in a primary care setting, a study was conducted to determine patient reaction to a masked alcohol screening questionnaire. The disguised questionnaire was developed to improve the accuracy of self-reported drinking behavior and facilitate blinded randomization to an intervention and control group. Patient reaction was determined by a face-to-face structured interview. The interview was structured to elicit responses before and after the patient was informed of the true nature of the questionnaire. The sample consisted of 21 alcoholic and 33 nonalcoholic patients in a primary care clinic. Seventy-five percent of the respondents were comfortable not being fully informed when research procedures involve the use of disguised alcohol questionnaires. There was some discomfort over the deceptive nature of the questionnaire, but 83% of the subjects believed the deception was justified and necessary. Males and alcoholics in the sample were more comfortable not being fully informed about research procedures suggesting greater trust in the medical profession. Females, on the other hand, were more concerned than males about how a family member would react to the disclosure of family health information. Alcoholics and persons with only a high school education felt the use of disguised questionnaires improved their accuracy significantly more often than nonalcoholics or individuals in the sample who attended graduate school.     

Portable breath alcohol testers and drinking-driving behavior of convicted drunk drivers

The use of portable breath alcohol testers by convicted drunk drivers during a drinking-driving educational program had a nonsignificant impact on the frequency of drinking-driving episodes. The use of breath alcohol testers also failed to significantly reduce peak blood alcohol concentration during drinking-driving episodes. However, portable breath testers were used by certain drunk drivers in deciding not to drive after drinking as well as to slow or stop their drinking on occasion.     

The association between problematic alcohol use,risk perceptions,and e-cigarette use

ABSTRACT

Background: Use of e-cigarettes among college students has escalated, in part due to the perception that they are less harmful than traditional cigarettes and have other benefits such as circumventing smoking bans. College students also drink more heavily than other age groups, and e-cigarettes are associated with alcohol, especially among students who engage in problematic drinking.

Objective: The present study sought to determine if an interaction between problematic alcohol use and increased perceptions of benefits and decreased perceptions of risks of e-cigarettes would predict whether participants had ever used an e-cigarette.

Method: The present study included 1,133 undergraduate college students surveyed between November 2014 – November 2016. Participants were primarily Caucasian (82.3%) and female (78.1%). Participants completed questionnaires regarding demographics, smoking status/history, and expectancies.

Results: Higher levels of problematic drinking and higher perceived benefits of e-cigarette use were both associated with having tried e-cigarettes. This relationship was significant even when controlling for several covariates such as cigarettes smoking status. However, there was not a significant interaction between problematic alcohol use and perceived benefits or risks of e-cigarettes. There was also no relationship between risk perceptions of e-cigarettes and e-cigarettes use.

Conclusions: Both problematic alcohol use and perception of benefits of e-cigarettes were associated with having tried an e-cigarette. This finding is problematic as the use of e-cigarettes may influence further engagement in risky behaviors including problematic drinking or transitioning to regular cigarette use. Thus, it is important to develop interventions to help college students develop more accurate risk perceptions about e-cigarettes.     

Irish descent, religion, and alcohol and tobacco use

The West of Scotland has traditionally been a focus for Irish migration. Using data from two studies carried out in this region, one quantitative, the other qualitative, this paper shows little difference in drinking and smoking between Scots of Irish descent and other Scots. It does, however, show significant differences in these behaviours according to religious affiliation in adulthood. Rather than confirming the stereotype of Irish Catholics as heavy drinkers and smokers the present paper puts forward the hypothesis that drinkers and smokers are differentially retained in membership by different religious affiliations, and argues that this accounts for differences in reputation and in health-related behaviours.     

Evaluation of a rapid breath hydrogen analyzer for clinical studies of carbohydrate absorption

A second-generation gas chromatograph for the analysis of H₂ in expired air has been developed. It incorporates a solid-state detector with high sensitivity for H₂ and has a small, internal pump which supplies air as the carrier gas, thus eliminating the need for a large tank of compressed gas for the carrier. A reference gas of known H₂ concentration is, of course, still required. The entire system weighs 6.0kg and is completely portable, requiring only 120 V electric current for use. The instrument has a mean intersample interval of less than 2 min, with H₂ concentration registered on a digital display. The output has a track-hold feature which permits the output, in parts per million H₂, to be retained by the meter so the reading can be verified. The chromatogram can also be recorded on a conventional analog strip-chart recorder. The sensitivity and precision are superior to those of a thermal conductivity H₂ gas chromatograph. Moreover, the rapid response time encourages frequent calibration checks with the reference gas. This analyzer offers significant advantages over previous H₂-measuring systems for breath-analysis tests used both for diagnostic clinical practice and for field studies of nutritional assessment. INCAP Publication No. I-1268 Dr. Solomons is a recipient of a Clinical Investigator Award (1 K08-AM-00715) from the National Institutes of Health (NIH).