The alcohol clamp: applications, challenges, and new directions--an RSA 2004 symposium summary

This article summarizes the proceedings of a symposium organized and cochaired by Vijay Ramchandani and Sean O'Connor and presented at the 2004 Research Society on Alcoholism meeting in Vancouver, BC, Canada. The objectives of this symposium were: (1) to provide a rationale for the development and use of the alcohol clamp and the requirements for its use in alcohol challenge studies; (2) to highlight recent studies conducted using the alcohol clamp to identify sources of variation in the pharmacokinetics and pharmacodynamics of alcohol, as well as to address important research questions related to the relationship between the response to alcohol and the risk for alcoholism; and (3) to provide a perspective on progress, address limitations of the clamp, and identify new directions for alcohol challenge research. The symposium began with an introduction and overview of the alcohol clamp, by Vijay Ramchandani. This was followed by 4 presentations that highlighted recent studies conducted using the clamp including: (1) determination of the influence of alcohol dehydrogenase polymorphisms on alcohol elimination rates in a male Jewish population, by Yehuda Neumark; (2) examination of family history of alcoholism, recent drinking history, and levels and rates of administration as determinants of the response to alcohol and risk for alcoholism, by Sean O'Connor; (3) evaluation of the time course of ethanol intoxication on neuroendocrine function in humans, by Ulrich Zimmermann; and (4) a study of the effects of steady-state blood alcohol levels on auditory event-related potentials in rats, by Sandra Morzorati. Harriet de Wit summarized and discussed the research presented at the symposium and provided her perspective on future directions for research using the alcohol clamp.     

Recent research on the comorbidity of alcoholism and pathological gambling

This article summarizes a symposium held at the 2002 Annual Meeting of the Research Society on Alcoholism in San Francisco, CA, and was prepared on behalf of the symposium participants by the symposium co-organizers/co-chairs. Prior research with both clinical and nonclinical populations indicates a high comorbidity between alcohol-use disorders and pathological gambling. This symposium involved a set of papers in which exciting new research on this form of comorbidity was presented. The studies spanned populations of problem-gambling helpline callers, problem gamblers attempting to recover, and community-recruited gambler research volunteers. The studies used methodologies ranging from questionnaire and interview to laboratory-based paradigms (i.e., cognitive and alcohol challenge). Study designs ranged from cross-sectional to longitudinal and from correlation to experiment. The symposium highlighted novel approaches that researchers are using to enhance understanding of functional relations that may underlie this common comorbidity.     

Introduction to the Symposium

In June 1995, the National Institute on Alcohol Abuse and Alcoholism sponsored a symposium on "Alcohol and Osteoporosis" at the Research Society on Alcoholism in Steamboat Springs, Colorado. The goals of the symposium were to: (a) disseminate current information on the effects of alcohol on osteoporosis, both deleterious and beneficial; (b) discuss the mechanisms, direct and indirect, by which alcohol affects bone remodeling; and (c) encourage research in the area of alcohol and osteoporosis. This report provides an introduction to the problem, as well as to the three scientific presentations. Key Words: Alcohol, Osteoporosis, Bone.     

Implicit and explicit alcohol-related cognitions

This article presents the proceedings of a symposium at the 2001 RSA Meeting in Montreal, Canada organized by Reinout W. Wiers and Alan W. Stacy. The purpose of the symposium was to present recent applications of implicit cognitive processing theory to alcohol research. Basic cognitive research has demonstrated that implicit cognition influences memory and behavior without explicit recall or introspection. The presentations from this symposium show that implicit cognition approaches yield new insights into understanding drinking motivation. The presentations were: (1) An introduction by Alan W. Stacy; (2) Implicit cognition and alcohol use. Involvement of other variables? (Susan L. Ames); (3) Alcohol expectancies and the art of implicit priming (Jane A. Noll); (4) Parental alcoholism and the effects of alcohol on semantic priming (Michael A. Sayette); (5) Implicit arousal and explicit liking of alcohol in heavy drinkers (Reinout W. Wiers); and (6) Negative affective cues and associative cognition in problem drinkers (Martin Zack). Comments were provided by the discussant Marvin Krank. The presented studies demonstrated that: (1) implicit memories of alcohol associations are powerful predictors and cross‐sectional correlates of alcohol use; (2) implicit retrieval processes influence alcohol outcome expectancies and alcohol consumption; (3) alcohol consumption influences implicit memory processing; (4) heavy drinkers reveal different affective responses in implicit and explicit tasks; and (5) negative affect exerts an implicit priming effect for alcohol associations in problem drinkers. These findings illustrate the importance of implicit cognition in understanding alcohol abuse and demonstrate the potential of the theoretical framework for more widespread application across a variety of areas of alcohol research, including diagnostics for the risk of alcohol abuse, treatment, and prevention.     

Advancing the expectancy concept via the interplay between theory and research

Four papers from a 2001 Research Society on Alcoholism symposium on expectancy theory and research are summarized. The symposium contributors describe recent advances in expectancy theory and discuss their implications for assessment and for understanding the processes of development and change in the behavioral domain of alcohol use. First, findings are integrated across the diverse domains in which the expectancy concept has been applied. Second, the implications of expectancy theory for the measurement of expectancy structure and process are examined. Third, research and theory regarding alcohol expectancy development and change are presented, with an emphasis on the role of expectancies as mediators of known antecedents of drinking. Finally, an experimental procedure for investigating the causal role of expectancies is described, together with its implications for theory testing and prevention or intervention programming. Collectively, the symposium contributions demonstrate the utility of an integrated expectancy theory for the generation of innovative research operations and new insights regarding behavior development and change. Consistent with the notion of consilience, expectancy theory has demonstrated a convergence of findings across different levels of analysis, as well as across different operations, methods, and research designs.     

Identification and brief treatment of alcohol problems with medical patients: an international perspective

This article summarizes the proceedings of a symposium at the 2002 RSA meeting in San Francisco, California. The chair was Peter Monti and co-chair was Nancy Barnett. The aim of the symposium was to bring together researchers from the United States, Sweden, and Mexico to present current findings on the development and implementation of screening and intervention research in Emergency Departments (ED). Cheryl Cherpitel presented findings on the performance of the Rapid Alcohol Problems Screen (RAPS4), a 4-item instrument used for screening for alcohol dependence and harmful drinking in the ED. Dr. Cherpitel also presented for her collaborator, Guilherme Borges, their research on the performance of a number of screening measures including the RAPS among Mexicans and Mexican-Americans with alcohol-related disorders in the ED. Preben Bendtsen described the implementation of an alcohol screening and intervention procedure delivered by ordinary ED staff in Sweden. Nancy Barnett presented data on characteristics related to readiness to change alcohol use in a sample of young adults who were treated in an ED for injury or intoxication.     

Chemosensory factors influencing alcohol perception,preferences, and consumption

This article presents the proceedings of a symposium at the 2002 RSA/ISBRA Meeting in San Francisco, California, co-organized by Julie A. Mennella and Alexander A. Bachmanov of the Monell Chemical Senses Center. The goal of this symposium was to review the role that chemosensory factors (taste, smell, and chemical irritation) play in the perception, preference, and consumption of alcohol. The presented research focused on both humans and laboratory animals and used a variety of approaches including genetic, developmental, pharmacological, behavioral, and psychophysical studies. The presentations were as follows: (1) Introduction and overview of the chemical senses (Julie A. Mennella and Alexander A. Bachmanov); (2) Taste reactivity as a measure of alcohol palatability and its relation to alcohol consumption in rats (Stephen W. Kiefer); (3) Early learning about the sensory properties of alcohol in laboratory animals (Juan Carlos Molina); (4) Early learning about the sensory properties of alcohol in humans (Julie A. Mennella); (5) Genetic dissection of the ethanol-sweet taste relationship in mice (Alexander A. Bachmanov and Michael Tordoff); and (6) Human genetic variation in taste: connections with alcohol sensation and intake (Valerie B. Duffy and Linda M. Bartoshuk). The symposium concluded with a general discussion.     

The Veterans Aging Cohort Study: observational studies of alcohol use, abuse, and outcomes among human immunodeficiency virus-infected veterans

This article represents the proceedings of a symposium at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL. The organizers/chairs were Joseph Conigliaro and Amy Justice. The presentations were (1) Introduction, by Joseph Conigliaro and Tamra Madenwald; (2) Alcohol and HIV/AIDS: the importance of integrative and translational research, by Kendall Bryant; (3) Alcohol use and abuse among patients with HIV infection, by Joseph Conigliaro and Stephan Maisto; (4) Severity of comorbid alcohol use/abuse in HIV infection, by Amy Justice and Jeffrey Samet; (5) Estimating the impact of alcohol use on long-term HIV outcomes, by Scott Braithwaite and Amy Justice; (6) Homelessness, drug & alcohol use among HIV+ veterans, by Adam Gordon and Robert Cook; and (7) Hepatitis C & alcohol in the VACS 3 study, by Shawn Fultz and Kevin Kraemer. The symposium concluded with a discussion led and facilitated by Diedra Roach.     

Treating Adolescents Together or Individually? Issues in Adolescent Substance Abuse Interventions

This article summarizes the proceedings of a symposium, chaired by Peter Monti and cochaired by Tracy O'Leary, that was presented at the 2001 RSA Meeting in Montreal, Quebec. The aim of this symposium was to present data on group- and individual-based interventions for adolescent alcohol and substance abuse, with a discussion of the implications of research findings bearing on developmental considerations when working with adolescents and young adults. Elizabeth J. D'Amico, PhD, reviewed recent findings on adolescents' choice of type of substance abuse treatment. Jennifer L. Maggs, PhD, presented a developmental perspective on this issue. Tracy O'Leary, PhD, presented data on enhancing motivational interviewing with the presence of a supportive peer for college students cited for alcohol infractions. Mary E. Larimer, PhD, presented 1-year follow-up results of the Greeks 2000 Project, a 5-year longitudinal study designed to evaluate the efficacy of an alcohol abuse prevention program provided to college students who were entering a pledge class (first year) of Greek houses. Barbara McCrady, PhD, a noted expert on the treatment of couples for substance abuse problems, served as discussant.     

Approaches to brief intervention for hazardous drinking in young people

This article represents the proceedings of a symposium at the 2002 joint conference of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism in San Francisco. The chair was John B. Saunders. The focus of the symposium was on brief intervention approaches for hazardous drinking among young people. The presentations were (1) Evidence for the effectiveness of brief intervention as an approach to reducing hazardous alcohol use, by John B. Saunders; (2) College student hazardous drinking in New Zealand, the USA, UK, and Australia: implications for research, policy, and intervention, by Kypros Kypri; (3) Applications of motivational feedback on the college campus, by Scott T. Walters; (4) A population based individualized alcohol harm reduction feedback intervention: preliminary results from the college-based alcohol risk reduction (CBARR) trial, by Robert G. Laforge; and (5) Brief interventions: conclusions and future directions, by Mary E. Larimer.     

The Validity of DSM‐IV Alcohol Dependence: What Do We Know and What Do We Need to Know?

This article presents the proceedings of a symposium at the 2002 RSA Meeting in San Francisco, California. Deborah S. Hasin organized the symposium and co-chaired it with Marc Schuckit. The purpose of the symposium was to provide an overview of what is known about the validity of DSM-IV and ICD-10 alcohol dependence and abuse, with a focus on work done since 1994. Presentations included: (1) Validity of DSM-III-R alcohol dependence in adolescents, by Christopher S. Martin; (2) Reliability and validity of DSM and ICD formulations of alcohol use disorders: findings from epidemiology, by Bridget F. Grant; (3) Validity and reliability of the alcohol-dependence phenotype in the context of genetic studies, by Kathleen K. Bucholz; and (4) DSM-IV and beyond: uniting the clinical utility of categories with the precision of dimensions, by John E. Helzer. The findings supported the validity of DSM-IV alcohol dependence across numerous study designs and samples, suggested some value in a dimensional dependence measure, and raised questions about the validity of the diagnosis of alcohol abuse as currently defined. Marc Schuckit, as discussant for the symposium, placed the issues in perspective for the upcoming DSM-V.     

Challenges applying alcohol brief intervention in diverse practice settings: populations, outcomes, and costs

This article summarizes the proceedings of a symposium at the 2005 Research Society on Alcoholism, Santa Barbara, California. The purpose of the symposium was to address challenges that arise in translating evidence for efficacy of alcohol brief intervention (BI) into diverse clinical settings and populations by reviewing the literature and describing 4 research studies. Dr. Saitz reviewed the limitations in evidence for efficacy of BIs and then described results of a randomized clinical trial of brief motivational intervention for medical inpatients drinking risky amounts. Dr. Svikis presented alternative methods for identifying pregnant women in prenatal care at risk for alcohol and drug problems (including nicotine and caffeine) and BIs to reduce or eliminate use. Dr. D'Onofrio discussed results of a randomized trial of the brief negotiated interview in emergency department patients. Dr. Kraemer presented results of a decision analytic and computer-simulation model regarding the cost-effectiveness of alcohol screening and intervention in primary care settings. Finally, Dr. Perl discussed the salient issues and suggested future directions for work in the area of alcohol BI.     

Multidisciplinary perspectives on impaired control over substance use

This article presents the proceedings of a symposium held at the June 2005 meeting of the Research Society on Alcoholism in Santa Barbara, California. Impaired control over substance use has long been considered a central feature of alcohol and drug dependence. However, much remains to be learned about the nature of impaired control, the mechanisms by which acute and chronic substance use can lead to impaired control, and how this construct is best assessed in the laboratory and the clinic. The goal of this symposium was to describe current perspectives on impaired control over alcohol and drug use from diverse research areas, to promote future multidisciplinary work in this area. Four speakers described their work on impaired control using human clinical samples (Dr. Chung), animal models (Dr. Miczek), experimental laboratory paradigms in humans (Dr. Fillmore), and neuroimaging studies (Dr. Easdon). Taken together, the talks highlighted the heterogeneous nature of constructs such as impaired inhibitory control, and patterns of impulsive and compulsive substance use. Future clinical and experimental research should attempt to carefully define and measure particular aspects of impaired control and to seek insights from other disciplines.     

Predicting Risky Drinking Outcomes Longitudinally: What Kind of Advance Notice Can We Get?

This paper summarizes the proceedings of a symposium presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, that spans the interval from toddlerhood to early middle adulthood and addresses questions about how far ahead developmentally we can anticipate alcohol problems and related substance use disorder and how such work informs our understanding of the causes and course of alcohol problems and alcohol use disorder. The context of these questions both historically and developmentally is set by Robert Zucker in an introductory section. Next, Maria Wong and colleagues describe the developmental trajectories of behavioral and affective control from preschool to early adolescence in a high risk for alcoholism longitudinal study and demonstrate their ability to predict alcohol and drug outcomes in adolescence. Duncan Clark and Jack Cornelius follow with a report on the predictive utility of parental disruptive behavior disorders in predicting onset of alcohol problems in their adolescent offspring in late adolescence. Next, Kenneth Leonard and Gregory Homish report on adult development study findings relating baseline individual, spouse, and peer network drinking indicators at marriage onset that distinguish different patterns of stability and change in alcohol problems over the first 2 years of marriage. In the final paper, John Schulenberg and colleagues, utilizing national panel data from the Monitoring the Future Study, which cover the 18- to 35-year age span, show how trajectories of alcohol use in early adulthood predict differential alcohol abuse and dependence outcomes at age 35. Finally, Robert Zucker examines the degree to which the core symposium questions are answered and comments on next step research and clinical practice changes that are called for by these findings.     

Complying with the minimum drinking age: effects of enforcement and training interventions

This article summarizes the proceedings of a symposium presented at the 2004 Research Society on Alcoholism meeting in Vancouver, British Columbia, organized by Alexander C. Wagenaar and chaired by Mark S. Goldman. The purpose of the symposium was to present the design and outcomes from a recently completed multi-community controlled time-series trial entitled Complying with the Minimum Drinking Age (CMDA), which tested two approaches for enhancing the effectiveness of the legal drinking age policy: training of alcohol retailers, and police enforcement at alcohol establishments. Specific presentations were: (1) Introduction and Overview of the CMDA project by Alexander C. Wagenaar, (2) CMDA Interventions by Traci L. Toomey, (3) CMDA Measurement, Statistical Methods and Results by Darin J. Erickson, and (4) Conclusions, Implications and Future Applications by Alexander C. Wagenaar. Results from the trial show: (1) minimal effects of the brief version of Alcohol Risk Management training for alcohol outlet management, (2) significant effects of enforcement checks in reducing sales of alcohol to youth, (3) a concentration of effects in specific alcohol outlets experiencing an enforcement check with little diffusion of effects to other outlets in the community not experiencing a check, and (4) a substantial decay of enforcement effects over the three months following a specific check. In short, results showed significant and substantial specific deterrence effects, and little training effects. Results also illustrated the utility and strength of the controlled time-series trial research design. Additional research on temporal and geospatial distribution of community-level intervention effects is warranted.     

New developments in prevention and early intervention for alcohol abuse in youths

This article summarizes a symposium held at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, British Columbia, Canada. It was prepared by the conference co-organizers/co-chairs with substantial input from each of the symposium participants. Increasingly, alcohol abuse interventions focus on preventing alcohol problems or intervening early before risky drinking behavior becomes ingrained. Universal prevention programs have produced no or only modest effects on the drinking behavior of youths. Although some existing targeted prevention programs have proved effective, they have not tapped the full range of potential intervention targets, such as the underlying motivations for alcohol misuse in youths who are at greatest risk. The set of papers presented in this symposium outline exciting new developments in the field of targeted prevention and early intervention programs for adolescent drinking problems, presented by an international panel of researchers. These developments include attention to making interventions relevant to adolescents' lives, focus on personality and motivational factors underlying alcohol misuse, and combining existing cognitive behavioral programs with expectancy challenge and motivational interviewing techniques.     

Advances in alcoholism research in Germany

This article presents the proceedings of a symposium at the 2004 International Society for Biomedical Research on Alcoholism meeting in Heidelberg/Mannheim, Germany, put together by the German Society of Addiction Therapy and Research (DG-Sucht e.V.). The aim was to give an overview on recent findings from animal to human studies that were conducted by several research groups engaged in the alcoholism field in Germany for longer periods. Results of his animal studies were presented by J. Wolfgramm; G. Buehringer reported on epidemiologic and psychotherapeutic research advances on alcohol-related disorders in Germany. L. G. Schmidt summarized results of novel diagnostic and therapeutic approaches in alcohol dependence, and J. Boening focused on biopsychological personality traits as predictors for relapse in alcoholism. Data relating hyperhomocysteinemia and brain shrinkage in patients with alcoholism were presented by J. Kornhuber. Four addiction research networks federally funded represented their results in separate symposia and were therefore deliberately excluded from this symposium.     

Understanding alcohol expectancy effects: revisiting the placebo condition

This article summarizes a symposium organized and cochaired by Maria Testa and presented at the 2005 Annual Meeting of the Research Society on Alcoholism, in Santa Barbara, California. The symposium explored issues relevant to understanding the function of placebo conditions and to interpreting placebo effects. Cochair Mark Fillmore began with an overview of the use of placebo conditions in alcohol research, focusing on methodological issues. Jeanette Norris and her colleagues conducted a review of studies examining placebo conditions among women. They conclude that expectancy effects are limited to a few domains. Maria Testa and Antonia Abbey presented papers suggesting that placebo manipulations may result in unanticipated compensatory effects in actual or hypothetical social situations. That is, placebo participants may compensate for anticipated cognitive impairment through vigilant attention to situational cues. John Curtin's research suggests that the compensatory strategies of placebo participants appear to involve a sensitization of evaluative control, resulting in improved performance. Kenneth Leonard provided concluding remarks on the meaning of placebo effects and the value of placebo conditions in research.