Boffins on Booz

Number of off-licences impacts on teenage hospital admissions

Alcohol Concern has issued a new report which shows that the number of off-licences in an area has a direct correlation with the number of teenagers hospitalised for alcohol -related conditions.  Studying off licence density and hospital admission across the UK "The analysis uncovered a statistically significant relationship between the density of off-licensed premises and alcohol specific hospital admissions in young people under-18-years-old.



The researchers analysed data from across the country of those admitted to hospital for alcohol poisoning or intoxication between 2006 and 2009.  'Linear regression modelling found that nationally on average every two extra off-licences per 100,000 of population results in one alcohol specific hospital admission of a person under-18- years-old per 100,000 of population. In general, as the density of off-licences in an area increases, so do alcohol specific admissions in young people... Availability rather than any other external factor is the cause of one in ten of such harms'

However the report warns that the harms measured may be an under-recording of the true picture. Hospitals exclude conditions related to alcohol such as head injuries or sprains resulting from alcohol related assaults or falls, or attendances that are dealt with only at A&E. In addition, 'hospital admissions that are specific to alcohol consumption may not necessarily be recorded as such. They are often only recorded according to the treatment provided and not the cause of the event'.

Why not London?

Interestingly the researchers excluded London from their data.  'No statistical relationship between off-licence density and harms in young people was found in data from the London boroughs resulting in their exclusion from the findings'.  This surprising result is supported though by the 'London: The highs and the lows' report from the Greater London Alcohol and Drug Alliance.  Comparing London with the rest of the UK the reporters discovered that 'young Londoners are less likely to drink alcohol than their peers in other parts of the country. Thirty eight per cent of the young Londoners participating in the survey reported that they had never tried alcohol, compared with only 18 per cent of the sample as a whole'.  The reason given is that inner London is 'an area with a high proportion of minority ethnic communities. ...People from these communities tend to consume less alcohol than people of white British ethnicity.... participants who were less likely to consume alcohol regularly were Muslim, took part in religious observances weekly or more often, and were of Bangladeshi, Pakistani, Indian, Caucasian, other, black African or black British ethnicity'. In support of this view, the Alcohol Concern data shows hospitalisation at its densest in areas of the country away from the mixed populations of the larger cities, with Lincoln and Gateshead topping the poll for off licences and hospitalisation.

Policy implications

The implications of the Alcohol Action report are clear. As Don Shenker, Chief Executive of Alcohol Concern, said:

“It is a failing of the current system that so many licences are being granted without due consideration to young people’s health... Local licensing committees are currently operating with one arm tied behind their backs. Current licensing legislation does not give licensing committees enough power to restrict high density of licensed premises. A new health objective should be included in the Licensing Act to enable local authorities to refuse new licenses in order reduce alcohol-related harm and protect young people."
For The Guardian report link here. For the full Alcohol Concern report click here.

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Alcohol related collateral damage and the weekend warriors

In Addiciton Journal this month, Thomas F Babor writes that the 'negative effects from others' drinking were reported by over 70% of Australians in the past year, with 51% experiencing serious adverse effects'.  The article considers how to measure these negative consequences of alcohol and draws in particular on the Laslett and co assessment of 'how the drinking of individuals can affect the social fabric of a society' and the Giesbrecht et al study of 'collateral damage' from the ‘second-hand effects of drinking’.

Oxford Street Party
Babor praises Laslett's 'service' and says "in brief, the authors have provided a national-level assessment of how the drinking of individuals can affect the social fabric of a society.  The impact is widespread and significant in terms of psychological, physical, social and economic costs.  Although Australia may not be representative of countries with lower levels of per capita income and alcohol consumption, the article raises some fascinating questions about the ways in which alcohol-related problems are defined, conceptualized, measured, and controlled"

Babor asks what the negative social consequences of alcohol are.  He identifies 'spoiled social occasions, emotional wounds, arguments, physical violence, workplace problems, failed expectations, care demands, embarrassment and exposure to physical risk'.  But he also suggests that we should identify and quantify 'the many other consequences that are more subtle, chronic and unseen.  These include chronic stress, failed marriages, maladaptive family dynamics, unwanted noise, broken bottles and trash to clean up, childhood psychological trauma, fetal alcohol spectrum disorders, neighborhood crime, family members' increased health care needs, and environmental degradation connected with the production of alcoholic beverages'.

Exploring methodological issues and the implication for policy on the way,  Baber ends with an equally arresting discussion of  how the terminology used might help to bring a wider public to the debate. He suggests renaming it 'alcohol-related collateral damage'.  This term he argues 'brings home the realization that in many communities, homes and families, the drinking environment has become a combat zone.  In this metaphor, the drinker, often a young male ‘weekend warrior’, is not only doing damage to himself and other drinkers, but also to innocent bystanders and others' property....Armed with bottles and intoxicated by alcohol's pharmacological powers are part of a broader political and economic system that is directing and profiting from the sale of alcohol, every bit as much as the military-industrial complex profits from the arms industry'.

For the full article follow the link.

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The effectiveness of on-line programmes for drinkers

Alcohol misuse and problem drinking are costly to health services, and while governements refuse to tackle the core problem of alcohol price, availability and marketing, they are increasingly turning to ready made, cheap and easily available solutions to problem drinking such as brief interventions.  Now online programmes are being looked at because they are also cheap and largely self-managed.  They are attractive to drinkers too for the same reasons, and for the anonymity and ease of access they offer.   But do they actually work?  Or as the UK findings bulletin published this week (24th July) puts it, 'which elements are important to improving effectiveness and who benefits most?'.



The bulletin discusses a US evaluation of the moderate drinking.com online support programme for 'people who want to change their drinking'.  As findings report, the study tested ''whether outcomes were improved by supplementing web-based information and mutual aid with a structured cognitive-behavioural programme built on the same principles, and whether these results differed depending on the severity of the user's drinking''.  80 participants were randomly allocated to one of two computer-based intervention packages tested by the study.   Both encouraged moderation of drinking and offered and encouraged participants to use information and an on-line 'mutual aid network'.  But the second programme also structured 'the methods recommended by Moderation Management (MM) in to a stage-by-stage, interactive cognitive-behavioural therapeutic programme personalised to the site user'. 

To cut a long story short, findings notes that drink-related problems 'had subsided to well below the average for the population and had continued to improve after three months'.  Moderatedrinking.com's own analysis also reports that 'at the first 3 month follow-up, those using the web application had reduced their drinking more than those only using MM.  By 12 months though, the MM only group caught up the experimental group in reduced drinking'.  The good news for the interactive cognitive programme was that it increased sober days to an impressive three out of seven, while the do-it yourself programme only achieved one and a half days sobriety per week.  Binge drinkers and heavy drinkers tended to be least helped. As the authors suggest 'dependent drinkers probably need more than take-it-or-leave-it access to an internet-based programme to make a difference over and above access to a mutual aid network'.

With the caveat that it is 'impossible to say how much of this was due to the interventions and how much to the pre-existing motivation of the participants', this is overall good news for these programmes, particularly for people wanting to manage an emerging drink problem that falls short of addiction.  But governments should certainly not be relying on them to tackle the drinking problems of the 40% of teenagers who binge drink or the 10% of adults with an alcohol addiction.  These drinkers were found to be largely beyond self-help alone.

Link to the original research study here.

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Alcohol industry shifts blame to parents for rise in teen-alcohol use

The alcohol industry continues to counter the claim that teenage drinking is on the rise as a result of sponsorship and advertising by questioning the role of parents in 'managing' their teenagers.  A new report by Family Lives and Drinkaware, the alcohol industry's 'education' arm has surveyed 600 children aged 10 to 17 and 800 parents, looking at the concerns of parents and the experiences that children are having with alcohol.  The study found that 'over a third of 13-15 year olds have seen photos of their friends drunk on social networking sites' and, as reported on the Drug Education Forum, the survey reports that '73% of 10-17 year olds say they want to speak to their parents first about the range of issues they are encountering'.  

Paul Wallis of Drinkaware tells you how to talk to teens
 
The strong message in the report is that parents are failing their children.  Without any discussoin of the industry's own role in promoting a drinking culture, the rise of alcopops or the addictive nature of alcohol,  the Drinkaware survey reports instead that 'the results suggest that only 14% of parents with a 13-15 year old were aware their child had encountered alcohol...and there is a gap between the concerns that parents talk about - sex, drugs and smoking - and the experiences that adolescents are having'.  To help the organisations have produced a top-tips list 'which they hope will be of practical use to parents'.

Of course parents should and will want to give advice and be responsible for their children, but the implication that parents are at fault for what Drinkaware are calling the 'reality gap' in awareness of the growing teen drinking culture that is rampant in the UK is a little hypocritical from an industry that has refused to curb the sponsorship and marketing which has promoted that culture of drinking in the first place.  As the World Health Organisation has shown,  governments which have failed to regulate advertising and marketing and allowed relatively free access to alcohol are at fault for the alarming rise in drinking in recent years, not parents who collectively are being accused of a mysterious decision to care less about their children in recent years.

If there is any doubt that the UK alcohol industry is driving this 'blame the parents' agenda, a quick visit to the Drinkaware site confirms the trouble being gone to in order to promote the idea.  Amongst the many articles there advising parents about drinking is one asking 'why you could be unintentionally putting your children in danger'.  Two articles make the assumption that teens will be drinking and discuss simply 'getting the timing right and what form the conversation should take in tackling your teens alcohol habit' and 'tips on keeping your children safe from harm if they are drinking alcohol'.  There is also a link to a video from Drinkaware's Chief Medical Adviser discussing 'the issues around talking to children about alcohol' in which Professor Paul Wallis talks earnestly to parents about the mysterious world of teenage drinking.

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Alcohol illness cost Irish hospitals €800,000,000 over 5 years

An exclusive report by Priscilla Lynch in the Medical Independent looks at the cost of alcohol-related illness in Irish hospitals, which accounted for 9% of all bed spaces in 2000- 2004, 15% of the total health budget and a cost of €805,158,217.  The figures relate to a time when de-regulation of sales and advertising of alcohol had not fully kicked in, after which alcohol consumption per adult in Ireland rocketed to the highest in Europe. The current picture will therefore almost certainly be worse.

 

Followed up in the journal.ie the report finds that the young men are the most likely to end up in hospital.
Young to middle-aged men were the most likely to spend the night in hospital because of alcohol-related problems, with a total of 37 per cent of all male bed days wholly contributed to alcohol. In contrast, the proportion of women being kept overnight solely because of alcohol-related problems stood at 25 per cent, according to the study.

Read the Medical Independent report



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Pre-natal drinking causes later problems for teenagers

Drinking while pregnant is likely to cause conduct disorders in adolescence says a major study conducted by the University of Pittsburgh School of Medicine, published online this year.  Many studies have looked at the critical but extreme problem of fetal alcohol syndrome, but this study looks at the long term effects of drinking while pregnant on all children for many years after birth.  The study followed 592 drinking and non drinking parents' children up to the age of 16 years to see what kind of behavioural problems might occur and if there were significant differences between the children of  mothers who drank and those who did not.


For the study "women were interviewed at their fourth and seventh prenatal months, and with their children, at birth, 8 and 18 months, 3, 6, 10, 14, and 16 years postpartum.  Offspring were interviewed with the Diagnostic Interview Schedule-IV; maternal and adolescent diagnoses were made using DSM-IV criteria at age 16 years. The sample was 592 adolescents and their mothers or caretakers".

The results were conclusive, showing that 'prenatal alcohol exposure is significantly associated with an increased rate of conduct disorder in the adolescents'.  The effect was also detected after just 'one or more drinks per day in the first trimester'.  Nearly 60 percent of the affected patients were male and almost 36 percent of children with conduct disorder had mothers who had at least one drink per day in the first trimester of pregnancy. 

The effect remained significant after 'controlling for other variables including measures of the environment, maternal psychopathology, and other prenatal exposures'.  The study concludes that 'more than one drink of alcohol per day consumed by a pregnant woman, especially during the first trimester of pregnancy, increases the chances of behavioral problems up to three times in the adolescence period. Alcohol intake during pregnancy should be considered a risk factor for behavioral disorder among adolescents'.

Link to the full report
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The Biology Behind Alcohol-Induced Blackouts

Some research states the obvious. That alcohol causes blackouts and memory loss is not going to make the front page, but a study by neuroscientists at Washington University School of Medicine in St. Louis, published in the Journal of Neuroscience on June 6th has found that alcohol does not necessarily damage brain cells so much as interfere with memory function.  As the university report puts it, "Exposure to large amounts of alcohol does not necessarily kill brain cells as once was thought.  Rather, alcohol interferes with key receptors in the brain, which in turn manufacture steroids that inhibit long-term potentiation (LTP), a process that strengthens the connections between neurons and is crucial to learning and memory.  Better understanding of what occurs when memory formation is inhibited by alcohol exposure could lead to strategies to improve memory".


Connections between receptors weakened
 Yukitoshi Izumi, research professor of psychiatry at Washington University School of Medicine in St. Louis explains that  "The mechanism involves NMDA receptors that transmit glutamate, which carries signals between neurons.  An NMDA receptor is like a double-edged sword because too much activity and too little can be toxic. We’ve found that exposure to alcohol inhibits some receptors and later activates others, causing neurons to manufacture steroids that inhibit LTP and memory formation.”
Further, says senior investigator Charles F. Zorumski. ““It takes a lot of alcohol to block LTP and memory but the mechanism isn’t straightforward. The alcohol triggers these receptors to behave in seemingly contradictory ways, and that’s what actually blocks the neural signals that create memories. It also may explain why individuals who get highly intoxicated don’t remember what they did the night before.”

Less convincing though is the scientists' assertion that “even at the high levels we used here, we don’t see any changes in how the brain cells communicate. You still process information. You’re not anesthetized. You haven’t passed out. But you’re not forming new memories.”.  Not sure that fits with the anecdotal evidence to be seen in any pub on any night you care to choose. Driving safely or making sense while you talk is surely a function of more than just memory? 


No change in how brain cells communicate

For the full report see the Washington University News

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Young people, alcohol and influences

A major Joseph Rowntree Foundation report was published on 17th June into young people and drinking in England.  The study surveyed (through validated self-reports) 5,700 school pupils aged between 13 and 16, to identify patterns of drinking and the strongest predictors of drinking.   It looked at how young people get to hear about and take their first drinks, the influences on them and their subsequent drinking behaviour.  As the report summarises "While friends play a critical role, family has a strong direct and indirect influence. This ranges from the point at which alcohol is introduced, to exposure to adult drinking and drunkenness, to the amount of supervision placed on a young person".



Drinking levels inevitably grow with age, and 79% of the 15-16 year olds reported that they have beendrunk, with over half drunk more than once.  In many cases, getting drunk is intentional, with 66% saying that they and their friends drink to get drunk at least once a month.

The report summarises its' findings that young people are 'more likely to drink, to drink frequently and to drink to excess' if they:
 • receive less supervision from a parent or other close adult
• spend more than two evenings a week with friends or have friends who drink
• are exposed to a close family member, especially a parent, drinking or getting drunk
• have positive attitudes towards and expectations of alcohol
• have very easy access to alcohol.

The research team believe though that  'a carefully timed intervention could generate a positive outcome by reducing the likelihood that a young person will drink frequently and drink to excess. These interventions require co-ordination at a national, local and frontline level involving families, schools and support services'.

Read the summary and full report here>>>
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Young women and alcohol peer research project

An interesting peer research study which employed young women (aged 17-22) from Cheshire and Merseyside to interview their peers (aged 13-22) about alcohol use is available this month (June) from ChaMPs public health network.  It gives a unique insight into the attitudes and habits of young women and the role of alcohol in their lives.  The study uses a qualitative approach, and it would be difficult to generalise from the findings which are very subjective in nature, but it gives an authentic picture.
Peer Researcher

The young researchers explored and found evidence to support their view that:
'Young women drink as a result of peer influence and to attain peer status' and drinking 'is felt to be normal behaviour for teenagers'. Alcohol itself 'is easily accessible and relatively cheap', and 'young women are not aware of the limits and risks they face; as a result of this they drink more alcohol'.

The study quotes directly from the young women. “We wait outside off licenses, and get people to go in for us” and “I know loads of people that have their stomach pumped but I still drink”.

Findings
As well as being revealing about lifestyles, the researchers asked about the effectiveness of current alcohol education programmes. 'The young women felt they were being overloaded with continuous information regarding alcohol awareness and the information that was received was concerned with extreme consequences and medical conditions...this sort of information does not deter them from drinking alcohol...  Information about alcohol should focus on more immediate risks and consequences'. 

The report makes a number of useful recommendations, chief among them strategies to address its central findings about the ready availability of alcohol, and the fact that regular drinking is seen as both 'normal' and 'essential', and is strongly reinforced by peer pressure.


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World Health Organisation: Fetal alcohol syndrome: dashed hopes, damaged lives

This month (June 2011) the WHO publishes a bulletin on FAS education programmes in Moscow, and the work of  campaigners in Western Cape, which has the world's highest reported FAS.  While rates in the Cape are running at up to 80 babies per 1,000, global rates are at nearly one in a thousand.  Heavy drinking during pregnancy can lead to spontaneous abortion or a range of disabilities known as fetal alcohol spectrum disorders, of which fetal alcohol syndrome is the most severe.  Children with this condition are born with characteristic physical and mental defects, including short stature, and small head and brain.  There is no cure.    Treatment is focused on mental health and medical services to manage the resulting lifelong disabilities that include learning difficulties, behavioural problems, language, delayed social or motor skills, impaired memory and attention deficits.   Yet in many countries the work of education and support is left largely to NGOs.

Denis Viljoen stands in front of his campaign poster
As researcher and human geneticist Denis Viljoen in Cape Town says in the bulletin, “It is estimated that at least one million people in this country have fetal alcohol syndrome and approximately five million have partial fetal alcohol syndrome and [other] fetal alcohol spectrum disorders. It’s tragic because it’s completely preventable”.  Studies show that poor nutrition, ill health, stress and tobacco use also influence the severity of the effects of heavy maternal drinking. The communities most affected are often impoverished, poorly educated and socially deprived.  As the bulletin notes, the costs to society are high. “Fetal alcohol syndrome is also an issue because affected children require special-needs schooling and other forms of specialized care. It really has knock-on effects.”

But despite education efforts, aslong as alcohol is accessible, affordable and socially acceptable, prevention work will be an uphill struggle.  Given the addictive power of alcohol, some women still drink heavily during pregnancy despite receiving the right advice. As a Cape mother said when advised to stop drinking while expecting her son: “I was hard-headed and just kept on drinking.”

Read the full report >>>>>>>>


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New research closer to identifying and treating cravings

Treating the transition to alcohol dependence is accompanied by gradually escalating levels of alcohol consumption during daily withdrawals.  Using alcohol dependent rats, Scripp's Reseach scientists used neuropeptide Y infusions during daily withdrawals which helped block the escalation of alcohol drinking.  The rats were consequently less likely to become dependent, and craved alcohol less.



"We've known for quite some time that neuropeptide Y is an endogenous [naturally occurring] anti-stress agent," says Markus Heilig, clinical director of the National Institute of Alcohol Abuse and Alcoholism (NIAAA). "We've also known that development of alcohol dependence gives rise to increased sensitivity to stress. This paper elegantly and logically brings these two lines of research together. It supports the idea that strengthening neuropeptide Y transmission in the amygdala would be an attractive treatment for alcoholism. The challenge remains to develop clinically useful medications based on this principle."

In the new research, published in the June 1, 2011 issue of the journal Biological Psychiatry, Scripps Research scientists demonstrated the key role of a receptor —a structure that binds substances, triggering certain biological effects—for neuropeptide Y in a part of the brain known as the central amygdala. The amygdala, a group of nuclei deep within the medial temporal lobes, performs an important role in the processing and memory of emotional reactions.


Read full report here>>>>>>>
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New Study: Alcohol Harms The Brain Immediately

The use of DTI scanners has increased our knowledge of how alcohol affects the brain, and the speed at which it does so, reports Medical News Today (30th May 2011).  Even a low dose of alcohol (0, 45 grams of alcohol per kilogram bodyweight) changed mood and behaviour of the participants. They were in a depressed mood, had increased speech, showed signs of excitement and suffered from headache and dizziness.

The new study by a Chinese research group shows that even low doses of alcohol can harm the brain immediately though not permanently. "We were investigating the acute effects of low and high doses of alcohol by diffusion tensor imaging, wondering whether the consequences of alcohol administration can be observed by the measurement of apparent diffusion coefficient (ADC) and fractional anisotropy (FA)", said Dr. Lingmei Kong (Shantou University Medical College, China) at the 21st Annual Meeting of the European Neurological Society (ENS) in Lisbon. 
The participants of the study did not only show reactions in their behaviour. The research group could also show that frontal lobes and thalamus are more vulnerable to the effects of acute alcohol consumption. And DTI is capable of detecting changes in the brain after acute alcohol consumption not visible on conventional MRI
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Dementia and alcohol: German study finds link to health benefits of alcohol, or does it?

A new study by Segfried Weyerer of the Central Institute of Mental Health in Mannheim, published recently in the Oxford Journal on behalf of the British Geriatrics Society, looks at alcohol consumption and the onset of dementia in over three thousand 75+ year-olds in German cities.  The study's initial conclusion is that alcohol consumption lowers the likelihood of dementia in that group by 30%.   However, the study contextualises the findings and adds several notes of caution before alcohol becomes a recommended medicine for the over seventies.


Winning Dementia Photo Andreas Philippides in Cyprus

The subjects were an average age of 80, so as the authors note, already great survivors.  And of those interviewed 50% did not take alcohol, suggesting itself that longevity is strongly associated with abstinence (less than 20% of the general population would be abstinent).  Of those who did drink, they were in the category of people already resistant to dementia, being well-off, educated, living with company and not suffering from depression.  Nearly 50% of them were also exclusively wine drinkers.  Of those who did drink alcohol and were therefore apparently more resistant to dementia than the drinkers, their consumption was on average 4 drinks per week or less.

So if you live to 80, are well off and want to avoid a 30% chance of being in the 7% who get dementia it may be better to drink a glass of wine every other day. If these conditions do not apply, you may still find yourself in the 10% of dementia sufferers who have alcohol induced dementia.  But unfortunately you will probably be in the the majority group of drinkers who do not live to 80 in the first place.

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Binge Drinking affects Memory in University Students

Dr. Maria Parada of Universidade de Santiago de Compostela has published a study in Alcoholism: Clinical & Experimental Research (16th May 2011) of memory function in 122 Spanish university students aged 18 to 20 years of age.  The students were divided into two groups – those who engaged in binge drinking and those that abstained.   She found that memory function was impaired for a s much a s several days in those who were binge drinkers.



Reported in the Telegraph, Dr Parada said:
Our main finding was a clear association between binge drinking and a lower ability to learn new verbal information in healthy college students, even after controlling for other possible confounding variables such as intellectual levels, history of neurological or psychopathological disorders, other drug use, or family history of alcoholism.  Whereas most attention has focused on negative consequences such as traffic accidents, violence or public disorder, society and students themselves are unaware of the damaging effects binge drinking may have on the brain.

The study abstract describes how:

'Binge drinking, which is characterized by sporadic consumption of large quantities of alcohol in short periods, is prevalent among university students. Animal studies have shown that BD is associated with damage to the hippocampus, a region of the brain that plays a key role in learning and memory. The temporal cortex undergoes structural and functional changes during adolescence. The aim of the present study was to examine the association between BD and declarative memory in male and female university students.

Results: The BD students remembered fewer words in the interference list and displayed greater proactive interference in the RAVLT; they performed worse in the Logical Memory subtest, both on immediate and delayed recall. There were no differences between the groups in performance of the Family Pictures subtest.

Conclusions: Binge drinking is associated with poorer verbal declarative memory, regardless of sex. The findings are consistent with the vulnerability of the adolescent hippocampus to the neurotoxic effects of alcohol. Longitudinal studies will help determine the nature of this relationship, the neurodevelopmental trajectories for each sex, and the repercussions on academic performance'.



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Universal school-based prevention programs for alcohol misuse in young people

A major review of alcohol prevention programmes in schools, conducted by David R Foxcroft and Alexander Tsertsvadze of Oxford Brookes University and the University of Ottawa was published online in March 2011 by the Cochrane Library. The study looks in particular at the effectiveness of educating young people about alcohol misuse through the school curriculum, as a single issue intervention or as part of a general programme of life skills training. Hands down the latter was the most successful, and the Europa Unplugged life skills programme was singled out for praise this side of the Atlantic. This tends to support the position of the Drug Task Force in Ireland which has resisted calls for (ineffective) short-term scare tactic interventions on the dangers of drug or alcohol use, and adds to the evidence which supports the effectiveness of life coaching programmes such as Life Ring or CBT. 


School alcohol education workshop

 The study offers:

 “Some clear advice on how to address alcohol use amongst teenagers. We decided to produce an updated review of randomised trials evaluating the effectiveness of universal school-based prevention programs for alcohol misuse amongst youth 18 years or younger.

The aim was to systematically review evidence on the effectiveness of universal school-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age. The specific aim of this review was to determine if psychosocial and educational prevention programs prevent alcohol misuse compared to standard school curriculum or other types of interventions.

Amongst the generic prevention programs, those based on psychosocial or developmental approaches (e.g., life skills through the LST program in the United States; social skills and norms through the Unplugged program in Europe; development of behaviour norms and peer affiliation through the GBG in the United States and in Europe) were more likely to report statistically significant effects over several years (up to 12 years with the GBG) when compared to standard school curriculum or other types of interventions, with effect sizes that are often small but potentially important based on economic models. Generic programs offer the additional advantage of potentially impacting on a broader set of problem behaviours, for example cannabis, tobacco, harder drugs, antisocial behaviour. Overall, we conclude that the evidence supports certain generic prevention programs over alcohol-specific prevention programs.

Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program in the United States, the Unplugged program in Europe, and the Good Behaviour Game in both the United States and Europe. However, given variability in effects between studies and between subgroups within studies, it is recommended that particular attention is paid to program content and delivery context, ideally through conducting further evaluation studies alongside any further implementation in different settings”.    Full report availabe online

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Decline in Age of Drinking Onset in Ireland

A study of the amount we spend on alcohol in Ireland and the age at which people first drink is published online this week (May 16th 2011: Alcohol and Alcoholism Journal, Bobby Smyth et al Department of Public Health & Primary Care, Trinity College Dublin). The findings confirm that a growing concern with alcohol consumption in Ireland is not misplaced. Not only has there been a steady increase in per capita spending on alcohol, but ‘The average age of first drinking fell steadily and significantly across birth cohorts from the late 1930s to the early 1990s’. Moreover ‘per capita alcohol consumption was very highly negatively correlated with the median age at which each birth cohort commenced drinking’.

Teenage binge drinking
Drinking at a younger age is particularly worrying in the light of research which suggests that 40% of those who start drinking at 16 or younger are likely to end up with alcohol addiction problems.  The research published this week in Alcohol and Alcoholism believes that ‘Per capita consumption may be contributing to the changes in age of onset of drinking and/or both may share a similar set of determinants’.   Other research suggests though that advertising and marketing to young people is significant in shaping drinking behaviour, and may arguably be a factor independent of the spending habits of the rest of the country.  However, it is of obvious concern that the drinking habits of adults are shaping those of young people, and as the study recommends ‘ In light of this apparent relationship, it is possible that efforts to reduce per capita alcohol consumption may also reduce underage drinking’.

Abstract:

We sought to examine the fall in age of first drinking in Ireland and to determine whether there were gender differences. We also aimed to determine whether there was a relationship between the per capita alcohol consumption evident when people entered later adolescence and their age of drinking onset. Methods: Information on age of first drinking was based on retrospective recall of 9832 interviewees from the pooled samples obtained from two population surveys. We examined the change in age of first drinking, by birth cohort and by gender, utilizing survival analysis. We utilized Pearson's correlation to explore the relationship between median age of first drinking within each birth cohort and the mean per capita alcohol consumption when that birth cohort was aged 16 years. Results: The average age of first drinking fell steadily and significantly across birth cohorts from the late 1930s to the early 1990s. This change was significantly greater in females. Per capita alcohol consumption was very highly negatively correlated with the median age at which each birth cohort commenced drinking (r = −0.96, P < 0.001). Conclusion: The prevailing level of drinking in society at the point when young people enter later adolescence is very closely associated with the age at which they commence drinking. Per capita consumption may be contributing to the changes in age of onset of drinking and/or both may share a similar set of determinants. In light of this apparent relationship, it is possible that efforts to reduce per capita alcohol consumption may also reduce underage drinking.



How Fetal Alcohol Syndrome (FAS) affects learning

New research to be published in August in Alcoholism: Clinical & Experimental Research, previewed in the Science Daily (May 16, 2011) finds that children of mothers who drank alcohol during pregnancy have reductions in the brain's deep gray matter volumes of up to 18%. The gray matter is responsible for integrating sensory and motor information on its way to the cortex, and its reduction would seem to explain the common symptoms of FAS such as impaired learning, emotion and memory.

As the study’s author Elizabeth R. Sowell, professor of pediatrics at the University of Southern California and Children's Hospital Los Angeles summarises the findings in Science Daily, "These structures integrate incoming sensory and motor information before it passes to the cortex. They are critical for functions such as learning, memory, and emotion and are often disproportionally affected in various conditions. Although we already knew that some of these structures were affected by alcohol exposure, it was unclear what the extent of damage was or whether it was the same in children and teens."

FAS facial features

The researchers examined two groups matched on age (6 to 17 years) and gender with high resolution structural magnetic resonance imaging: 28 (16 males, 12 females) diagnosed with FASD, and 56 (32 males, 24 females) without FASD (2 controls per each FASD subject).

"The deep gray matter volume was reduced in all six structures examined in the children and adolescents with FASD," says co-author Christian Beaulieu, professor in biomedical engineering in the faculty of medicine and dentistry at the University of Alberta. "Volume reductions were observed over a wide age range. Less volume could be readily thought of as having less horsepower under the hood. Smaller structures would have less capacity to facilitate communication between different brain regions."

"The differences were substantial at seven to 18 percent," added Sowell, "when compared to controls, suggesting that these structures are considerably affected by alcohol during fetal development. This may indicate an underlying basis for some of the behavior, learning, and memory problems observed in children and adolescents with FASD." Read the full article

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The effects of a modest dose of alcohol on executive functioning and prospective memory
No surprise that alcohol affects the quality of work, but a study in Dublin confirmed that a night of social drinking will cause mistakes in surgery performed the next morning. Now a study published in Human Psychopharmacology this month (May 2011) looks at the negative effects on office work of taking even a tiny amount of alcohol - participants given only 0.4g of alcohol (a standard drink being 20 times more at 10g).

"The present study aimed to assess the effects of a modest dose of alcohol on executive functioning and PM using a virtual reality task and investigate the role of executive planning in PM performance.  Forty healthy participants were administered 0.4 g/kg alcohol or matched placebo in a double-blind design. Executive function and PM were assessed using the Jansari–Agnew–Akesson–Murphy (JAAM) task, requiring participants to play the role of an office worker.

Results
Alcohol intoxication selectively impaired executive function and PM. The participants in the alcohol condition performed worse on the planning, prioritisation, creativity and adaptability executive subscales and also on the time-based and event-based PM tasks. However, alcohol did not impair the selection executive function task or the action-based PM task. The results provide further support for the effects of alcohol on executive functioning and PM. In addition, the results suggest that such deficits may be present at relatively modest doses of alcohol and in the absence of a subjective feeling of intoxication".  Read More

Making sense of teenage alcohol experiences
A Dutch study investigates adolescents' accounts of incidents with alcohol

This March 2011 study by the Institute for Behavioral Research, University of Twente, explores how alcohol use is incorporated in the lives of young adolescents in the Netherlands. Teenagers see bad experiences of alcohol as positive, and so it doesn't make them alter their drinking intentions. Critical incidents involving alcohol use are analyzed. Special attention is paid to the consequences associated with alcohol use, the role of the parents, and the way adolescents evaluate incidents and link them to behavioral intentions.
A total of 145 incidents were described. Many different, mostly adverse, consequences were associated with the incidents. Parents were not always aware of incidents, and if they were, they often did not take them seriously. The study shows that alcohol is already deeply rooted in the lives of adolescents. The role of parents appears to be problematic. Furthermore, the study underlines the complexity of the problem of adolescent alcohol use. If their own negative experiences and first-hand observations do not substantially lead to lower drinking intentions, it does not seem plausible that alcohol information and education materials focusing on consequences will. More


World Health Organsation Global Alcohol Survey March 2011

The Global status report on alcohol and health (2011) presents a comprehensive perspective on the global, regional and country consumption of alcohol, patterns of drinking, health consequences and policy responses in Member States. It represents a continuing effort by the World Health Organization (WHO) to support Member States in collecting information in order to assist them in their efforts to reduce the harmful use of alcohol, and its health and social consequences. The report was launched in Geneva on Friday 11 Februray 2011 during the first meeting of the WHO global counterparts for implementation of the global strategy to reduce the harmful use of alcohol. More

Trinity College Study of Drinking and Pregnancy April 2011

Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptual alcohol consumption. Methods: A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week). Results: Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment. More

The effects of changing opening hours on alcohol related incidents and harm
American Journal of Preventive Medicine 2010
All of the studies included in this review assessed the effects of increasing hours of sale in on-premises settings (in which alcoholic beverages are consumed where purchased) in high-income nations. None of the studies was conducted in the U.S. The review team’s initial assessment of this evidence suggested that changes of less than 2 hours were unlikely to signifıcantly affect excessive alcohol consumption and related harms; to explore this hypothesis, studies assessing the effects of changing hours of sale by less than 2 hours and by 2 or more hours were assessed separately.

There was suffıcient evidence in ten qualifying studies to conclude that increasing hours of sale by 2 or more hours increases alcohol-related harms. Thus, disallowing extensions of hours of alcohol sales by 2 or more should be expected to prevent alcohol-related harms, while policies decreasing hours of sale by 2 hours or more at on-premises alcohol outlets may be an effective strategy for preventing alcohol-related harms. More


Universal school-based prevention programs for alcohol misuse in young people

A major review of alcohol prevention programmes in schools, conducted by David R Foxcroft and Alexander Tsertsvadze of Oxford Brookes University and the University of Ottawa was published online in March 2011 by the Cochrane Library.  The study looks in particular at the effectiveness of educating young people about alcohol misuse through the school curriculum, as a single issue intervention or as part of a general programme of life skills training.  Hands down the latter was the most successful, and the Europa Unplugged life skills programme was singled out for praise this side of the Atlantic.  This tends to support the Drug Task Force in Ireland which has resisted calls for (ineffective) short-term scare tactic interventions on the dangers of drug or alcohol use, tends to underline the effectiveness of life coaching programmes such as Life Ring or CBT.



School alcohol education workshop



The study offers:

 “some clear advice on how to address alcohol use amongst teenagers.  We decided produce an updated review of randomised trials evaluating the effectiveness of universal school-based prevention programs for alcohol misuse amongst youth 18 years or younger.
The aim was to systematically review evidence on the effectiveness of universal school-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age. The specific aim of this review was to determine if psychosocial and educational prevention programs prevent alcohol misuse compared to standard school curriculum or other types of interventions. 

Amongst the generic prevention programs, those based on psychosocial or developmental approaches (e.g., life skills through the LST program in the United States; social skills and norms through the Unplugged program in Europe; development of behaviour norms and peer affiliation through the GBG in the United States and in Europe) were more likely to report statistically significant effects over several years (up to 12 years with the GBG) when compared to standard school curriculum or other types of interventions, with effect sizes that are often small but potentially important based on economic models.   Generic programs offer the additional advantage of potentially impacting on a broader set of problem behaviours, for example cannabis, tobacco, harder drugs, antisocial behaviour. Overall, we conclude that the evidence supports certain generic prevention programs over alcohol-specific prevention programs.

Implications for practice

Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program in the United States, the Unplugged program in Europe, and the Good Behaviour Game in both the United States and Europe. However, given variability in effects between studies and between subgroups within studies, it is recommended that particular attention is paid to program content and delivery context, ideally through conducting further evaluation studies alongside any further implementation in different settings”.

Implications for practice