Entering treatment for alcohol abuse: a stress and coping model

This study used a stress and coping model to examine the process of entering treatment among 515 problem drinkers without prior formal treatment for alcohol abuse mho were recruited at alcoholism information/referral (I&R) and detoxification centers. Over a 1-year follow-up period, 76% of the individuals in the sample entered some form of treatment, including Alcoholics Anonymous. People were more likely to enter treatment if they perceived their drinking problem as more severe, had more dependence symptoms, experienced more adverse consequences as a result of drinking, had more symptoms of depression, were more self-derogating, experienced more negative life events in the past year, and/or experienced more stressors in various life domains. Facilitative factors also related positively to treatment entry: people who had sought help from non-formal treatment sources before, who recalled being referred to treatment programs by and I & R center, and/or who received detoxification at a center that had treatment services available on-site, also were more likely to enter treatment. For people with greater resources in multiple life domains the positive effects of days intoxicated, dependence symptoms and stressors on help-seeking were intensified. Overall, the findings suggest that perceived severity of drinking problem plays a central role in the treatment entry process and mediates the effects of many other intrapersonal and environmental variables in generating an impetus or readiness to seek treatment.     

Alcohol consumption, alcohol abuse and alcohol dependence. The United States as an example

This paper presents national estimates of alcohol consumption and DSM-IV alcohol abuse and dependence in the United States, Fifty-nao percent of the adults surveyed were classified as current drinkers and nearly 9.0% met criteria for DSM-IV akohol abuse or dependence. Greater percentages of males and whiles were classified as current drinkers and as alcohol abusers or dependent, compared with females and non-whites., respectively. There is a need for future epidemiological research to collect belter data on drinking patterns as an aid to interpreting socio-demographic differentials and to estimate more precisely the association between alcohol consumption and abuse and dependence in multivariate statistical environments. The critical need to examine the unprecedented reversal of the abuse-to-dependence ratio resulting from the application of the DSM.-IV classification is emphasized. The role of future longitudinal alcohol epidemiological research in elucidating the initiation and maintenance of consumption patterns and alcohol use disorders is stressed.     

Nonhuman primate models for lymphoma, leukemia, and other neoplasms.

Herpesvirus saimiri (HVS) is an oncogenic virus for a variety of nonhuman primates. HVS does not produce overt disease upon inoculation in the natural host (squirrel monkey) but consistently induces neoplasms including lymphomas and lymphocytic leukemias in 4 other species of monkeys. Various drugs inhibit replication of HVS in vitro including cytosine arabinoside and adenine arabinoside. In addition, the lymphoma and leukemia induced in owl monkeys responds to vincristine and prednisolone, cyclophosphamide, cytosine arabinoside, and human interferon. Of the various chemical carcinogens studied, the antitumor agent procarbazine induces neoplasms in a variety of species including monkeys. Thus far this compound has induced acute myelogenous leukemia (AML), lymphoma, and hemangiosarcomas in macaques. We have induced primary liver tumors in macaques with several nitrosamines and aflatoxin B1 and these tumors produce alpha-fetoprotein (AFP) which can be assayed for both diagnosis and therapy. Thus far, therapy of hepatocellular carcinoma has been most successful with surgical resection; and the tumor mass and serum AFP have been less responsive to single agent chemotherapy. These nonhuman primate models are useful for an understanding of the cause, diagnosis, prevention, and treatment of the human disease.     

The costs of the detrimental effects of alcohol abuse have grown faster than alcohol consumption in Finland

Between 1980 and 1990 alcohol consumption in Finland grew on average by 2.4% per year, and most of the detrimental effects of alcohol abuse grew faster. The real costs from nearly all alcohol-related detrimental effects grew during the 1980s on average by 1.7–2.4% annually, depending on the item. As a result of the volume and cost development the direct detrimental effects of alcohol abuse grew from FIM 1.0–1.3 billion in 1980 to FIM 2.8–3.7 billion in 1990: i.e. a real increase of 51–56% in the direct costs of detrimental effects. The indirect costs of detrimental effects (production losses, value of life lost through premature death), was FIM 9.9–18.1 billion in 1990. In 10 years the distribution of the costs of direct detrimental effects changed markedly, in particular regarding health and social costs: the share of health costs decreased 6 percentage points, while that of social costs increased 10 percentage points.     

From the Cover: Nonhuman primate model of schizophrenia using a noninvasive EEG method

There is growing evidence that impaired sensory-processing significantly contributes to the cognitive deficits found in schizophrenia. For example, the mismatch negativity (MMN) and P3a event-related potentials (ERPs), neurophysiological indices of sensory and cognitive function, are reduced in schizophrenia patients and may be used as biomarkers of the disease. In agreement with glutamatergic theories of schizophrenia, NMDA antagonists, such as ketamine, elicit many symptoms of schizophrenia when administered to normal subjects, including reductions in the MMN and the P3a. We sought to develop a nonhuman primate (NHP) model of schizophrenia based on NMDA-receptor blockade using subanesthetic administration of ketamine. This provided neurophysiological measures of sensory and cognitive function that were directly comparable to those recorded from humans. We first developed methods that allowed recording of ERPs from humans and rhesus macaques and found homologous MMN and P3a ERPs during an auditory oddball paradigm. We then investigated the effect of ketamine on these ERPs in macaques. As found in humans with schizophrenia, as well as in normal subjects given ketamine, we observed a significant decrease in amplitude of both ERPs. Our findings suggest the potential of a pharmacologically induced model of schizophrenia in NHPs that can pave the way for EEG-guided investigations into cellular mechanisms and therapies. Furthermore, given the established link between these ERPs, the glutamatergic system, and deficits in other neuropsychiatric disorders, our model can be used to investigate a wide range of pathologies.     

Associations between work stress, alcohol consumption and sickness absence

Aims. To test an interactional model on the associations between work stressors, perceived stress, alcohol consumption and sickness absence. Design. Cross-sectional survey. Setting. The study was part of a Worksite Health Project including an Employee Assistance Programme and a Health Promotion Programme in the Netherlands. Participants. Participants were blue-collar workers from two Municipal Garbage Collecting Departments and white-collar workers from a Pharmaceutical Company (N=471). Measurements. Measurements included socio-demographic characteristics (gender, age, education, marital status), work stressors, perceived stress, alcohol consumption and sickness absence. Type of work-site (blue- or white-collar) and smoking behaviour were used as covariates. Findings. Regression analyses resulted in three major findings. First, in the presence of stress, abstinence increased the risk of sickness absence compared with moderate drinking. We failed to find a significant relationship between excessive drinking and sickness absence. Secondly, stress mediated the associations between stressor and alcohol consumption, and between stressor and sickness absence, although stressors also directly predicted sickness absence. Conclusions. The association between abstinence and sickness absence could reflect medical problems of abstainers or a lack of skills for coping with stress. The failure to find a significant detrimental effect of excessive drinking may have been due to use of a low threshold for excessive drinking and/or low power. Prospective studies are needed to gain insight in causal relationships between the variables concerned.     

Patterns of alcohol consumption: beverage effects on gender differences

This Data Note reports findings from 22 102 current drinkers who responded in the US National Interview Survey in 1988. Mean estimated alcohol intake of males exceeded that of females by a factor of two. Males drank more per occasion (ratio 1.45) and drank on more occasions (1.41). Mean ethanol content per drink was slightly less for males (ratio 0.95) attributable to a decreased proportion of drinks being wine and liquor. When beverage preferences were taken into account, the drinking patterns of males and females showed no meaningful differences among persons with similar levels of overall ethanol intake. The results do not support the view that the difference between ethanol consumption of males and females are due primarily to males drinking more per occasion. Apparent differences in drinking patterns are attributable to differences in preferred beverage.     

Chronotype and personality factors in the daily consumption of alcohol and psychostimulants

This paper analyses the influence of and possible interaction between chronotype (Morning-types, Neither-types and Evening-types} and personality dimensions (neuroticism, extroversion and psychoticism) in the daily consumption of alcohol and psychostimulants (nicotine and caffeine). In a sample of 537 subjects (257 men and 280 women), who were students and professionals with different but fixed work schedules, there were significant differences among the chronotypes regarding the consumption of all the above. Evening-types consumed more alcohol, nicotine and caffeine (coffee and cola), while Morning-types consumed more caffeine from tea. Personality was only related to the consumption of cola: the greater the neuroticism the higher the consumption of this beverage. Stimulant drinks showed various types of interaction with personality types, which revealed a complex pattern of group action. The results stress the need to consider chronotype as a contributory psychological factor in a multi-causal model of consumption of psychoactive substances.     

Adolescent substance abuse: the effects of alcohol and marijuana on neuropsychological performance

Background: Adolescence is a period in which cognition and brain undergo dramatic parallel development. Whereas chronic use of alcohol and marijuana is known to cause cognitive impairments in adults, far less is known about the effect of these substances of abuse on adolescent cognition, including possible interactions with developmental processes. Methods: Neuropsychological performance, alcohol use, and marijuana use were assessed in 48 adolescents (ages 12 to 18), recruited in 3 groups: a healthy control group (HC, n = 15), a group diagnosed with substance abuse or dependence (SUD, n = 19), and a group with a family history positive for alcohol use disorder (AUD) but no personal substance use disorder (FHP, n = 14). Age, drinks per drinking day (DPDD), percentage days drinking, and percentage days using marijuana were considered as covariates in a MANCOVA in which 6 neuropsychological composites (Verbal Reasoning, Visuospatial Ability, Executive Function, Memory, Attention, and Processing Speed) served as dependent variables. Results: More DPDD predicted poorer performance on Attention and Executive Function composites, and more frequent use of marijuana was associated with poorer Memory performance. In separate analyses, adolescents in the SUD group had lower scores on Attention, Memory, and Processing Speed composites, and FHP adolescents had poorer Visuospatial Ability. Conclusions: In combination, these analyses suggest that heavy alcohol use in adolescence leads to reduction in attention and executive functioning and that marijuana use exerts an independent deleterious effect on memory. At the same time, premorbid deficits associated with family history of AUD appeared to be specific to visuospatial ability.     

Environmental cues, alcohol seeking, and consumption in baboons: effects of response requirement and duration of alcohol abstinence

BACKGROUND: Environmental stimuli (cues) that have been paired with alcohol drinking may evoke classically conditioned states that in turn influence alcohol consumption and relapse to heavy drinking. Animal models using chained schedules of alcohol reinforcement may be useful for examining such complex interactions. METHODS: Alcohol drinking was established in 4 baboons. A sequence of lights and tones was presented during daily 3-hour sessions. First, cues were presented alone and no programmed contingencies were in effect. Second, cues were paired with 3 linked components consisting of different behavioral contingencies leading to and concluding with access to alcohol for self-administration in the last component (i.e., a chained schedule of alcohol reinforcement). Third, the effects of withholding alcohol access (i.e., forced abstinence) and increasing the number of lever responses required per drink were evaluated. RESULTS: Cues paired with a chained schedule of alcohol reinforcement engendered behaviors that brought baboons into contact with alcohol-related cues and occasioned operant responding that facilitated access to alcohol (alcohol seeking) during components that preceded alcohol access. Increasing the response requirement for each drink decreased the number of drinks and volume of alcohol consumed, but did not alter alcohol seeking. On the first session after 14 days of alcohol abstinence, latency to complete the operant requirement that produced alcohol access was decreased while both alcohol self-administration and volume of alcohol consumed were increased. CONCLUSIONS: Alcohol self-administration and consumption were sensitive to increases in response requirement and duration of alcohol abstinence, while seeking was only enhanced by duration of alcohol abstinence. This animal model may be useful to further examine the interactions between environmental cues and behaviors associated with seeking and consumption of alcohol and to evaluate the efficacy of potential alcohol treatment drugs on these behaviors.     

Attitudes toward alcohol and drug-free experience among college students: relationships with alcohol consumption and problems

This study examined prospective relations between attitudes toward alcohol use and drug-free experience and alcohol consumption and problems in 231 undergraduate students (73% women). Attitude toward drug-free experience was hypothesized to moderate the alcohol attitude--behavior relationship. Participants were assessed twice, separated by a 30-day interval. Attitude toward alcohol use at Time 1 was associated with alcohol consumption at Time 2. Time 1 attitude toward alcohol use and the interaction between the attitude variables were associated with problems at Time 2, indicating that attitude toward alcohol use was less associated with alcohol problems among participants with more positive attitudes toward drug-free experience. Attitude toward drug-free experience acted as a protective factor, reducing the relationship between alcohol attitude and alcohol-related problems.     

Gender differences in alcohol consumption: effects of measurement

Data from a 1988 survey of US drinking habits and related problems revealed differences in male and female patterns of alcohol consumption. Men were more likely than women to be current drinkers (64 v. 41%), and beer accounted for a larger proportion of their overall intake. Men's average daily ethanol intake was about twice as high as that of women, 17.5 v. 8.9 g. Adjustment for differences in body weight and composition substantially reduced the male-to-female ratio of consumption. Men were more likely than women to be classified as heavy drinkers, and the excess proportion of males so categorized increased with the severity of the measure of heavy drinking.     

Effects of alcohol control measures on alcohol consumption.

This paper first very briefly discusses different kinds of alcohol control measures, and after that reviews the available studies of the effects of control measures on alcohol consumption. During recent years the field of evaluation of alcohol control measures has matured and drawn on new technologies. The new prevention evaluation literature has also taken several directions. Taken together, the results of various studies have very clearly shown that control measures can influence drinking patterns, and in turn the rate of drinking problems. However, effects of changes in alcohol prices and availability are also determined by the social, cultural, and economic circumstances characteristic to each country and period.     

The cognitive effects of alcohol abuse: a controlled study

It is now well established that there is an association between excessive alcohol consumption and psychological impairment. However, there has been some difficulty in the interpretation of results as the majority of studies have relied on reporting correlations in large subject samples. It was felt therefore that if subjects were matched by variables which had been found to be confounding in previous research, a clearer picture of the effects of alcohol on cognitive functioning could be drawn. Subjects in this study were therefore divided into a ‘high’ alcohol group (over 50 units per week), and a ‘low’ alcohol group (under 20 units per week). No patients who had previously been reported as suffering from cognitive impairment were included in this study as the purpose of this research was to examine the effects of alcohol on those heavy drinkers with no obvious impairment. They were matched by age, sex, socio-economic status and educational background. Heavy drinkers showed significant deficits on a number of cognitive tests compared with their matched controls. Furthermore, the subjects in the lower educational group showed a greater decrease in scores on several sub tests than those in the higher group.     

Unrecorded alcohol consumption: its economics and its effects on alcohol control in the Nordic countries

The starting point of this paper is the fact that no country has complete records of alcohol consumption. In addition to being a matter or statistical accuracy, unrecorded alcohol also plays an important role in alcohol policy discussions. Furthermore, its quantity is bound to basic economic laws. These latter two aspects are the main interest in this paper, which discusses, first, what is really meant by unrecorded alcohol consumption and what kind of categories are included in it. The next task is to discuss the economics of different categories of unrecorded alcohol and the mechanisms which lead to increases or decreases in them. The examples in this part of the paper come from the Nordic countries. Arguments about increased smuggling and illegal distilling have always been used against alcohol policy restrictions in the Nordic countries. Recently the level of travellers' alcohol imports and border trade have also been used for the same purpose. In the European Union the task to harmonize alcohol excise taxes is partly given to increased travellers' duty-free allowances and market forces. This policy has already led to reductions in alcohol taxation both in Denmark and Sweden.     

Implications of co-occurring alcohol abuse for role impairment, health problems, treatment seeking, and early course of alcohol dependence

This article explores the nosological and clinical implications of co-occurring alcohol abuse and alcohol dependence and examines the hierarchical relationship between these diagnostic categories in the DSM-IV. Among 2,307 alcohol-dependent participants in the 2003 US National Survey on Drug Use and Health, 1,646 (68.1%) additionally met the criteria for alcohol abuse. In multivariate analyses, alcohol-dependent participants with alcohol abuse reported an earlier age of first alcoholic drink compared to those without alcohol abuse. They also reported a higher prevalence of health problems, non-alcohol drug use, impairment, treatment seeking, and early remission. The two groups had different symptom profiles. Revisions to future DSM editions are proposed to better capture these differences.