Alcohol Abuse

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Several medications can help people with alcohol use disorders maintain abstinence or reduce drinking, according to research from the University of North Carolina at Chapel Hill.

The work, published today in the Journal of the American Medical Association (JAMA) and funded by the Agency for Healthcare Research and Quality (AHRQ), provides additional options for clinicians to effectively address this global concern.

Although alcohol use disorders are associated with many health problems, including cancers, stroke and depression, fewer than one-third of people with the disorders receive any treatment and less than 10 percent receive medications to help reduce alcohol consumption.

“There are many studies that have tried to show whether certain medications can help with alcohol use disorders, but it is a lot of information to digest and many providers do not know what works or doesn’t work,” said Daniel Jonas, lead author of the study and professor in the department of medicine and the Cecil G. Sheps Center for Health Services Research. ”When you synthesize all the evidence, it shows pretty clearly that some medications do work.”

Jonas led a team from the RTI-UNC Evidence-based Practice Center to review published studies examining the use of drugs to treat alcohol use disorders. The researchers conducted a systematic review of 122 randomized controlled trials and one cohort study. They then graded the strength of the evidence on the impact of drugs on alcohol consumption.

They found that two drugs, acamprosate (brand name Campral) and oral naltrexone (brand name Revia), have the best evidence supporting their benefits. Both drugs reduced return to drinking and improved other drinking outcomes. Among medications used off-label (i.e., those not FDA approved for alcohol use disorders), moderate evidence showed improvement in some drinking outcomes for topiramate and nalmefene.

“The health implications of preventing return to drinking and reducing alcohol consumption are substantial,” said Jonas. ”Modeling studies have shown that such improvements would result in significant reductions in alcohol-attributable mortality, costs from health care, arrests and motor vehicle accidents.”

“This work expands upon the growing evidence that medications can play a valuable role in the treatment of alcohol use disorders,” said James Garbutt, professor of psychiatry and scientist at UNC’s Bowles Center for Alcohol Studies and senior author on the paper. “We are hopeful that this information will encourage clinicians to strongly consider these medications and that individuals will gain awareness that there are medications that can help them to stop or significantly reduce their alcohol use.”

The study was developed by the AHRQ-funded RTI-UNC Evidence-based Practice Center is a collaboration between RTI International and the University of North Carolina at Chapel Hill. Jonas co-directs the center with Meera Viswanathan at RTI. The review is an update of the first product of the center, which was published in 1999 in JAMA. Since 1999, there has been more than a tenfold increase in the number of individuals studied in controlled clinical trials of naltrexone and acamprosate, and many trials of medications that are not FDA-approved.

University of North Carolina at Chapel Hill

“Middle class professionals… are the country’s biggest problem drinkers,” is the stark and somewhat misleading claim in The Daily Telegraph, with similar claims appearing across the UK media.
The story is based on a study looking at just 49 ‘white collar’ people’s attitudes towards alcohol consumption.

Many of us enjoy a drink in the pub after work without realising how social drinking can damage health. Phil didn’t realise the harm his alcohol intake was doing until he was diagnosed with cirrhosis of the liver. He talks about his experience and the shock he felt at being diagnosed.

read more…..

NHS Choices

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High levels of drinking have repeatedly been shown to predict divorce. The most cited explanation for this is that excessive alcohol use disrupts daily tasks and functioning, and increases spousal conflicts. A study of the effects of drinking among husbands versus wives, and of similar versus dissimilar drinking in couples, has found that both level of drinking and compatibility in drinking can have an influence on divorce.

 
Results will be published in the May 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“On average, divorced people drink more than married people,” said Fartein Ask Torvik, a researcher at the Norwegian Institute of Public Health as well as corresponding author for the study. “To some extent, this is due to increased drinking after a divorce, but people who drink heavily also have a higher risk of experiencing a divorce, so heavy drinking likely interferes fundamentally with the quality of marriage.”

“Heavy alcohol consumption is a problem of great public health concern in most Western societies,” added Ellinor F. Major, director of the division of mental health at the Norwegian Institute of Public Health. “It often leads to dysfunctional marriages and divorces. The present study adds to our understanding of the predictive value of alcohol use, and particularly of discordant alcohol consumption for marital dissolution.”

Torvik and his colleagues used data from a previous health study, in which all inhabitants in a Norwegian county were invited to participate in a health study between 1984 and 1986: 19,977 married couples partook. All participants provided information on alcohol use and mental distress. Cox regression (“time-to-event” analysis) was used to study the risk for divorce during the next 15 years, using demographics and mental distress as covariates. “There was one earlier study of this issue,” said Torvik, “but we had a larger sample and a longer follow-up period.”

“Essentially, the more people drink, the higher is the risk of divorce,” said Torvik. “In addition, the risk of divorce is lowered if the spouses drink approximately the same amount of alcohol. This is not only true for those who drink excessively – there is also a reduced risk of divorce if both spouses abstain totally from alcohol. Also, we found heavy drinking among women to be more strongly associated with divorce than heavy drinking among men.”

“This latter finding is of major interest,” said Major. “For instance, the risk of divorce is estimated to be tripled when the husband’s level drinking is low and the wife’s drinking is heavy, compared with couples where both drink lightly.”

“There are several possible explanations for this,” said Torvik. “One of them is that women in general seem to be more strongly affected by heavy drinking than men are. Thus, heavy-drinking women may be more impaired than heavy-drinking men. It is, however, important to note that heavy drinking is much less common among women than among men.”

“Heavy drinking among women is also less acceptable than among men in our society,” said Major. “A wife’s heavy drinking probably also interferes more with general family life – that is, the caring role of the mother, upbringing of children, etc. Perhaps the husband is more apt to the leave the spouse than is the wife when major problems occur. These factors may account for the higher risk for marital dissolution when the wife is a heavy drinker than when the husband is a heavy drinker.”

“Research on alcohol use and relationships should always include data from both spouses,” said Torvik. “The interaction between the spouses is too important to ignore. Likewise, clinicians working with this population should be interested in the alcohol use of the spouse.”

“Couples who intend to marry should be aware of the drinking pattern of their partner since it may become a problem in the future,” added Major. “Someone with a light or moderate alcohol use, who has a spouse who drinks heavily, should encourage that spouse to change their drinking pattern into light or moderate level if the main concern is a lasting marriage of good quality. Good advice probably would be to encourage a similar pattern of moderate or light drinking in both spouses.”

“Furthermore, while our results indicate that compatibility in drinking is important with regard to divorce, a couple with two heavy drinkers still has a higher divorce risk than couples consisting of light drinkers,” noted Torvik. “I would also like to add that we have only been looking into divorce – alcohol may lead to other social or health problems.”

“Most couples in the present study have children,” said Major. “It would be of interest to study the benefits and disadvantages for the children if parents choose to stay or leave a marriage because of discordant or concordant heavy drinking. From the children’s point of view, parental divorce brings a lot of suffering, but nonetheless, marriage dissolution might be preferable for some children rather than parents staying in a marriage with poor quality.”


Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, “Discordant and Concordant Alcohol Use in Spouses as Predictors of Marital Dissolution in the General Population: Results from the Hunt Study,” were: Kristin Gustavson, Mariann Idstad, and Kristian Tambs of the Division of Mental Health at the Norwegian Institute of Public Health; and Espen Røysamb of the Division of Mental Health at the Norwegian Institute of Public Health, and the Department of Psychology at the University of Oslo. The study was funded by the Research Council of Norway. This release is supported by the Addiction Technology Transfer Center Network at http://www.ATTCnetwork.org.

Preventing teenage alcohol abuse

School-based psychological interventions reduce risk of alcohol misuse, finds new study

 
Targeted psychological interventions aimed at teenagers at risk of emotional and behavioural problems significantly reduce their drinking behaviour, and that of their schoolmates, according to the results from a large randomised controlled trial published today in JAMA Psychiatry. The authors argue that the intervention could be administered in schools throughout the UK to help prevent teenage alcohol abuse.

The ‘Adventure Trial‘ is led by Dr Patricia Conrod, King’s College London’s Institute of Psychiatry, in collaboration with the University of Montreal and Sainte-Justine University Hospital Center (Canada) and was commissioned by Action on Addiction.

The trial involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum. A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation seeking. All students were monitored for their drinking behaviour over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. 11 schools received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioural strategies for coping with their particular personality profiles.

Dr Patricia Conrod, from King’s Institute of Psychiatry and lead author of the paper, says: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves. Depending on their personality profiles, they might learn cognitive-behavioural strategies to better manage high levels of anxiety, to manage their tendency to have pessimistic reactions to certain situations or to control their tendency to react impulsively or aggressively. Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behaviour than giving teenagers general information on the dangers of alcohol.”

After two years, high-risk students in intervention schools were at a 29% reduced risk of drinking, 43% reduced risk of binge drinking and 29% reduced risk of problem drinking compared to high-risk students in control schools. The intervention also significantly delayed the natural progression to more risky drinking behaviour (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29% reduced risk of taking up drinking and 35% reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.

Dr Conrod adds: “Not only does the intervention have a significant effect on the teenagers most at risk of developing problematic drinking behaviour, there was also a significant positive effect on those who did not receive the intervention, but who attended schools where interventions were delivered to high-risk students. This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”

Dr Conrod concludes: “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”

Approximately 6 out of 10 people aged 11-15 in England report drinking, and in the UK approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons. Across the developed world, alcohol accounts for approximately 9% of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, Chief Executive of Action on Addiction says: “Dr Conrod’s study which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future is an exciting development for prevention work in the UK. This is generally recognised as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

King’s College London