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Open AccessArticle Alcohol Policy, Social Context, and Infant Health: The Impact of Minimum Legal Drinking Age

Int. J. Environ. Res. Public Health 2011, 8(9), 3796-3809; doi:10.3390/ijerph8093796

Received: 11 August 2011 / Revised: 2 September 2011 / Accepted: 2 September 2011 / Published: 23 September 2011

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Abstract

Objective: The minimum legal drinking age (MLDA) was increased in the U.S. in the late 1980s in an effort to reduce intoxication-associated injuries, especially those related to motor vehicle accidents. This paper explores distal (secondary) effects of changing MLDA on indices of

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Objective: The minimum legal drinking age (MLDA) was increased in the U.S. in the late 1980s in an effort to reduce intoxication-associated injuries, especially those related to motor vehicle accidents. This paper explores distal (secondary) effects of changing MLDA on indices of infant health, and whether changes in drinking behaviors or birth composition contributed to these effects. Methods: State- and year-fixed-effects models are used to analyze the relationship between MLDA, drinking behaviors, and birth outcomes. We studied the effects of different MLDA (age 18, 19, 20, or 21 years) when potential mothers were 14 years old by merging two population-based datasets, the Natality Detailed Files and the Behavioral Risk Factor Surveillance System between 1985 and 2002. Results: A MLDA of 18 years old (when potential mothers were 14 years old) increased the prevalence of low birth weight, low Apgar scores, and premature births. Effects were stronger among children born to black women compared with white women. Moreover, a younger MLDA was associated with an increasing proportion of very young and high school dropouts for black women. Furthermore, older MLDA laws at age 14 years decreased the prevalence of binge drinking among black women. Conclusions: Increasing the MLDA had longer term, distal impacts beyond the initially intended outcomes, specifically on birth outcomes (particularly among infants born to black women) as well as school drop-outs and binge drinking patterns among black young females. The older MLDA, intended initially to reduce problematic drinking behaviors, appeared to alter broader social contexts that influenced young women during their early childbearing years. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Alcohol Mixed with Energy Drinks: Consumption Patterns and Motivations for Use in U.S. College Students

by Cecile A. Marczinski

Int. J. Environ. Res. Public Health 2011, 8(8), 3232-3245; doi:10.3390/ijerph8083232

Received: 3 June 2011 / Revised: 30 July 2011 / Accepted: 30 July 2011 / Published: 5 August 2011

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Abstract

Binge drinking in college students is widespread and known to cause significant harms and health hazards for the drinker. One factor that may be exacerbating hazardous drinking in young people is the new popular trend of consuming alcohol mixed with energy drinks (AmED).

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Binge drinking in college students is widespread and known to cause significant harms and health hazards for the drinker. One factor that may be exacerbating hazardous drinking in young people is the new popular trend of consuming alcohol mixed with energy drinks (AmED). However, rates of AmED use and motivations for AmED consumption in college students have not been well established. In this study, 706 undergraduate college students from a university in the United States participated in a web-based survey that queried self-reported alcohol, energy drink, and AmED use. In addition, motivations for using AmEDs were assessed. The results indicated that for all participants, 81% reported that they have tried at least one energy drink in the past and 36% reported consumption of at least one energy drink in the past 2 weeks. Alcohol consumption patterns were similar to findings from U.S. national surveys of college drinking, as 37% of respondents were classified as binge drinkers and 23% abstained from drinking. In the whole sample (including the alcohol abstainers), 44% reported trying AmED at least once and 9% reported AmED consumption at least once in the past 2 weeks. 78% of respondents agreed with the statement that AmEDs appeal to underage drinkers. When AmED users were asked about various motivations for consuming AmEDs, users reported that they consumed these beverages to get drunk and reduce sedation compared to alcohol alone. In conclusion, the consumption of AmEDs is common in U.S. college students. Motivations for using AmEDs include the reduction of the sedative effects of alcohol, an important interoceptive cue that one should stop drinking. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Increasing and Decreasing Alcohol Use Trajectories Among Older Women in the U.S. Across a 10-Year Interval

by Janet Kay Bobo and April A. Greek

Int. J. Environ. Res. Public Health 2011, 8(8), 3263-3276; doi:10.3390/ijerph8083263

Received: 2 June 2011 / Revised: 13 July 2011 / Accepted: 13 July 2011 / Published: 5 August 2011

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Abstract

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50

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Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥3 biannual alcohol assessments during 1998–2008. The best-fitting model based on the drinks per day data had four trajectories labeled as “Increasing Drinkers” (5.3% of sample), “Decreasing Drinkers” (5.9%), “Stable Drinkers” (24.2%), and “Non/Infrequent Drinkers” (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Beneficial Effects of Ethanol Consumption on Insulin Resistance Are Only Applicable to Subjects Without Obesity or Insulin Resistance; Drinking is not Necessarily a Remedy for Metabolic Syndrome

by Hirokazu Yokoyama

Int. J. Environ. Res. Public Health 2011, 8(7), 3019-3031; doi:10.3390/ijerph8073019

Received: 1 June 2011 / Revised: 13 July 2011 / Accepted: 20 July 2011 / Published: 21 July 2011

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Abstract

Although moderate drinking has been shown to lower insulin resistance levels, it is still unclear whether alcoholic beverages could be remedies for insulin resistance. To elucidate this, the correlation between levels of ethanol consumption and insulin resistance were cross-sectionally examined in 371 non-diabetic

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Although moderate drinking has been shown to lower insulin resistance levels, it is still unclear whether alcoholic beverages could be remedies for insulin resistance. To elucidate this, the correlation between levels of ethanol consumption and insulin resistance were cross-sectionally examined in 371 non-diabetic male Japanese workers. Multiple regression analysis demonstrated that the ethanol consumption level was inversely correlated with the insulin resistance level assessed by homeostatic model assessment (HOMA-IR, p = 0.0014), the serum insulin level (p = 0.0007), and pancreatic β-cell function, also assessed by HOMA (HOMA-β, p = 0.0002), independently from age, body mass index (BMI), and blood pressure, liver function tests, and lipid profiles status, as well as serum adiponectin. The correlations were true in subjects with normal BMIs (up to 25.0 kg/m², n = 301) or normal HOMA-IR (up to 2.0 µIU·mg/µL·dL n = 337), whereas all of them were non-significant in those with excessive BMIs (n = 70) or in those with HOMA-IR of more than 2.0 (n = 34). Although it is still unclear whether the reductions of these parameters by ethanol consumption are truly due to the improvement of insulin resistance, at least, these effects are not applicable to subjects with obesity and/or insulin resistance. Thus, alcoholic beverages could not be remedies for insulin resistance or metabolic syndrome. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Hypothalamic Glial-to-Neuronal Signaling during Puberty: Influence of Alcohol

by Vinod K. Srivastava, Jill K. Hiney and W. Les Dees

Int. J. Environ. Res. Public Health 2011, 8(7), 2876-2894; doi:10.3390/ijerph8072894

Received: 26 May 2011 / Revised: 27 June 2011 / Accepted: 12 July 2011 / Published: 14 July 2011

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Abstract

Mammalian puberty requires complex interactions between glial and neuronal regulatory systems within the hypothalamus that results in the timely increase in the secretion of luteinizing hormone releasing hormone (LHRH). Assessing the molecules required for the development of coordinated communication networks between glia and

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Mammalian puberty requires complex interactions between glial and neuronal regulatory systems within the hypothalamus that results in the timely increase in the secretion of luteinizing hormone releasing hormone (LHRH). Assessing the molecules required for the development of coordinated communication networks between glia and LHRH neuron terminals in the basal hypothalamus, as well as identifying substances capable of affecting cell-cell communication are important. One such pathway involves growth factors of the epidermal growth factor (EGF) family that bind to specific erbB receptors. Activation of this receptor results in the release of prostaglandin-E₂ (PGE₂) from adjacent glial cells, which then acts on the nearby LHRH nerve terminals to elicit release of the peptide. Another pathway involves novel genes which synthesize adhesion/signaling proteins responsible for the structural integrity of bi-directional glial-neuronal communication. In this review, we will discuss the influence of these glial-neuronal communication pathways on the prepubertal LHRH secretory system, and furthermore, discuss the actions and interactions of alcohol on these two signaling processes. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Long-Term γ-Hydroxybutyric Acid (GHB) and Disulfiram Combination Therapy in GHB Treatment-Resistant Chronic Alcoholics

by Angelo Giovanni Icro Maremmani, Pier Paolo Pani, Luca Rovai, Matteo Pacini, Liliana Dell’Osso and Icro Maremmani

Int. J. Environ. Res. Public Health 2011, 8(7), 2816-2827; doi:10.3390/ijerph8072816

Received: 28 May 2011 / Revised: 15 June 2011 / Accepted: 29 June 2011 / Published: 6 July 2011

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Abstract

Leading Italian studies support the use of γ-hydroxybutyric acid (GHB), not only in the treatment of the alcohol withdrawal syndrome, but also in maintaining alcohol abstinence. GHB gives a better result than naltrexone and disulfiram in maintaining abstinence, and it has a better

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Leading Italian studies support the use of γ-hydroxybutyric acid (GHB), not only in the treatment of the alcohol withdrawal syndrome, but also in maintaining alcohol abstinence. GHB gives a better result than naltrexone and disulfiram in maintaining abstinence, and it has a better effect on craving than placebo or disulfiram. The problem is that about 30–40% of alcoholics are non-responders to GHB therapy. In our clinical practice, we speculate that by combining disulfiram with GHB treatment we may be able to achieve a kind of ‘antagonist’ effect by using the ‘psychological threat’ of disulfiram (adversative effect) while taking advantage of the anticraving effect of GHB, despite the limitation of its ‘non-blockade’ effect on alcohol. In this context, to improve the outcome in GHB long-term treated alcoholics, we added disulfiram to GHB in the management of GHB treatment-resistant alcoholics. In this study we compared retention in treatment of 52 patients who were treated with the GHB-disulfiram combination for up to six months, with retention for the same subjects considering their most recent unsuccessful outpatient long-term treatment with GHB only. An additional comparison was carried out on the days of complete abstention from alcohol. Thirty four patients (65.4%) successfully completed the protocol and were considered to be responders; 18 (34.6%) left the programme, and were considered to be non-responders. Considering the days of complete abstinence from alcohol, 36 patients stayed in treatment longer with the GHB-Disulfiram combination, 12 stayed for a shorter time and four for the same time. The results of this study seem to indicate a higher efficacy of the GHB-disulfiram association compared with GHB alone. Randomized controlled trials are now needed to verify this hypothesis. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Work and High-Risk Alcohol Consumption in the Canadian Workforce

by Alain Marchand, Annick Parent-Lamarche and Marie-Ève Blanc

Int. J. Environ. Res. Public Health 2011, 8(7), 2692-2705; doi:10.3390/ijerph8072692

Received: 16 May 2011 / Revised: 15 June 2011 / Accepted: 23 June 2011 / Published: 29 June 2011

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Abstract

This study examined the associations between occupational groups; work-organization conditions based on task design; demands, social relations, and gratifications; and weekly high-risk alcohol consumption among Canadian workers. A secondary data analysis was performed on Cycle 2.1 of the Canadian Community Health Survey conducted

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This study examined the associations between occupational groups; work-organization conditions based on task design; demands, social relations, and gratifications; and weekly high-risk alcohol consumption among Canadian workers. A secondary data analysis was performed on Cycle 2.1 of the Canadian Community Health Survey conducted by Statistics Canada in 2003. The sample consisted of 76,136 employees 15 years of age and older nested in 2,451 neighbourhoods. High-risk alcohol consumption is defined in accordance with Canadian guidelines for weekly low-risk alcohol consumption. The prevalence of weekly high-risk alcohol consumption is estimated to be 8.1% among workers. The results obtained using multilevel logistic regression analysis suggest that increased work hours and job insecurity are associated with elevated odds of high-risk alcohol consumption. Gender female, older age, being in couple and living with children associated with lower odds of high-risk drinking, while increased education, smoking, physical activities, and, and economic status were associated with higher odds. High-risk drinking varied between neighbourhoods, and gender moderates the contribution of physical demands. The results suggest that work made a limited contribution and non-work factors a greater contribution to weekly high-risk alcohol consumption. Limits and implications of these results are discussed. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Prevalence of Alcohol Use and Associated Factors in Urban Hospital Outpatients in South Africa

by Supa Pengpid, Karl Peltzer and Hendry Van der Heever

Int. J. Environ. Res. Public Health 2011, 8(7), 2629-2639; doi:10.3390/ijerph8072629

Received: 24 May 2011 / Revised: 21 June 2011 / Accepted: 22 June 2011 / Published: 28 June 2011

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Abstract

The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6%) consecutively selected patients from different hospital outpatient departments. Results

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The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6%) consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT). Two in five patients (40.5%) were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Prevalence of Children with Severe Fetal Alcohol Spectrum Disorders in Communities Near Rome, Italy: New Estimated Rates Are Higher than Previous Estimates

by Philip A. May, Daniela Fiorentino, Giovanna Coriale, Wendy O. Kalberg, H. Eugene Hoyme, Alfredo S. Aragón, David Buckley, Chandra Stellavato, J. Phillip Gossage, Luther K. Robinson, Kenneth Lyons Jones, Melanie Manning and Mauro Ceccanti

Int. J. Environ. Res. Public Health 2011, 8(6), 2331-2351; doi:10.3390/ijerph8062331

Received: 14 April 2011 / Revised: 17 June 2011 / Accepted: 17 June 2011 / Published: 22 June 2011

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Abstract

Objective: To determine the population-based epidemiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) in towns representative of the general population of central Italy. Methods: Slightly revised U.S. Institute of Medicine diagnostic methods were used among children

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Objective: To determine the population-based epidemiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) in towns representative of the general population of central Italy. Methods: Slightly revised U.S. Institute of Medicine diagnostic methods were used among children in randomly-selected schools near Rome. Consented first grade children (n = 976) were screened in Tier I for height, weight, or head circumference and all children Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Is the Demand for Alcoholic Beverages in Developing Countries Sensitive to Price? Evidence from China

by Guoqiang Tian and Feng Liu

Int. J. Environ. Res. Public Health 2011, 8(6), 2124-2131; doi:10.3390/ijerph8062124

Received: 16 May 2011 / Revised: 1 June 2011 / Accepted: 2 June 2011 / Published: 9 June 2011

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Abstract

Economic literature in developed countries suggests that demand for alcoholic beverages is sensitive to price, with an estimated price elasticity ranging from −0.38 for beer and −0.7 for liquor. However, few studies have been conducted in developing countries. We employ a large individual-level

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Economic literature in developed countries suggests that demand for alcoholic beverages is sensitive to price, with an estimated price elasticity ranging from −0.38 for beer and −0.7 for liquor. However, few studies have been conducted in developing countries. We employ a large individual-level dataset in China to estimate the effects of price on alcohol demand. Using the data from China Health and Nutrition Survey for the years 1993, 1997, 2000, 2004 and 2006, we estimate two-part models of alcohol demand. Results show the price elasticity is virtually zero for beer and only −0.12 for liquor, which is far smaller than those derived from developed countries. Separate regressions by gender reveals the results are mainly driven by men. The central implication of this study is, while alcohol tax increases can raise government revenue, it alone is not an effective policy to reduce alcohol related problems in China. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Heavy Drinking Is Associated with Poor Blood Pressure Control in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

by Suzanne E. Judd, Leslie A. McClure, Virginia J. Howard, Daniel T. Lackland, Jewell H. Halanych and Edmond K. Kabagambe

Int. J. Environ. Res. Public Health 2011, 8(5), 1601-1612; doi:10.3390/ijerph8051601

Received: 10 February 2011 / Revised: 29 April 2011 / Accepted: 5 May 2011 / Published: 17 May 2011

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Abstract

Alcohol intake has been shown to have a J-shaped association with blood pressure (BP). However, this association has not been examined in mixed race populations or in people with diabetes where tighter blood pressure control is recommended. Participants in the REGARDS study who

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Alcohol intake has been shown to have a J-shaped association with blood pressure (BP). However, this association has not been examined in mixed race populations or in people with diabetes where tighter blood pressure control is recommended. Participants in the REGARDS study who were 45 years or older (n = 30,239) were included. Medical history (including self-reported alcohol intake) was collected by telephone while blood collection and clinical measurements were done during an in-home visit. We defined diabetes as use of medications and/or fasting glucose ≥ 126 mg/dL and hypertension as use of blood pressure lowering medications and/or BP ≥ 140/90 mmHg or BP ≥ 130/80 mmHg in people with diabetes. After adjustment for confounders, heavy drinking was associated with an increased odds of hypertension (OR = 1.59; 95% CI = 1.37, 1.87). Diabetes and gender significantly modified (interaction P < 0.05 for both) the association between alcohol use and hypertension, although heavy drinking remained associated with increased odds of hypertension in sub-group analyses. We did not observe the previously described J-shaped relationship in any sub-group except white females. These data suggest heavy alcohol consumption is associated with poor BP control and that heavy drinkers may want to consider limiting alcohol intake in order to manage hypertension. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Receiving an Alcohol Enquiry from a Physician in Routine Health Care in Sweden: A Population-Based Study of Gender Differences and Predictors

by Barbro Engdahl and Per Nilsen

Int. J. Environ. Res. Public Health 2011, 8(5), 1296-1307; doi:10.3390/ijerph8051296

Received: 6 March 2011 / Revised: 7 April 2011 / Accepted: 19 April 2011 / Published: 27 April 2011

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Abstract

Research has shown that the provision of brief interventions in the health care system is effective for reducing hazardous drinking. Using a telephone-administered questionnaire, this study provides a population-based investigation on the extent to which physicians address patients’ alcohol habits in the Swedish

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Research has shown that the provision of brief interventions in the health care system is effective for reducing hazardous drinking. Using a telephone-administered questionnaire, this study provides a population-based investigation on the extent to which physicians address patients’ alcohol habits in the Swedish health care system, whether there are gender differences in the extent to which patients receive questions about alcohol, and predictors for receiving such questions. Data were obtained from monthly telephone surveys with around 72,000 people in 2006–2009. Having received an alcohol enquiry was defined as having been asked about one’s drinking habits by a physician in any health care visit in the last 12 months. Fourteen percent of the total population had received an alcohol enquiry, but there were considerable gender differences: for hazardous drinkers, 13% of the women and 17% of the men had received an alcohol enquiry; among those with sensible alcohol consumption, 10% of women and 15% of men had received an alcohol enquiry. Patients were more likely to have received an alcohol enquiry if they had self-reported alcohol-related problems, were hazardous drinkers and/or daily smokers. Some of the alcohol enquiry predictors differed by gender; social class was an important predictor for women but not for men. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Binge Drinking Effects on EEG in Young Adult Humans

by Kelly E. Courtney and John Polich

Int. J. Environ. Res. Public Health 2010, 7(5), 2325-2336; doi:10.3390/ijerph7052325

Received: 2 February 2010 / Revised: 1 April 2010 / Accepted: 7 May 2010 / Published: 10 May 2010

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Abstract

Young adult (N = 96) university students who varied in their binge drinking history were assessed by electroencephalography (EEG) recording during passive viewing. Groups consisted of male and female non-binge drinkers (>1 to 5/4 drinks/ounces in under two hours), low-binge drinkers (5/4–7/6 drinks/ounces

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Young adult (N = 96) university students who varied in their binge drinking history were assessed by electroencephalography (EEG) recording during passive viewing. Groups consisted of male and female non-binge drinkers (>1 to 5/4 drinks/ounces in under two hours), low-binge drinkers (5/4–7/6 drinks/ounces in under two hours), and high-binge drinkers (≥ 10 drinks/ounces in under two hours), who had been drinking alcohol at their respective levels for an average of 3 years. The non- and low-binge drinkers exhibited less spectral power than the high-binge drinkers in the delta (0–4 Hz) and fast-beta (20–35 Hz) bands. Binge drinking appears to be associated with a specific pattern of brain electrical activity in young adults that may reflect the future development of alcoholism. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Alcohol and HCV Chronic Infection Are Risk Cofactors of Type 2 Diabetes Mellitus for Hepatocellular Carcinoma in Italy

by Massimiliano Balbi, Valter Donadon, Michela Ghersetti, Silvia Grazioli, Giovanni Della Valentina, Rita Gardenal, Maria Dal Mas, Pietro Casarin, Giorgio Zanette, Cesare Miranda and Paolo Cimarosti

Int. J. Environ. Res. Public Health 2010, 7(4), 1366-1378; doi:10.3390/ijerph7041366

Received: 3 December 2009 / Revised: 8 February 2010 / Accepted: 15 March 2010 / Published: 29 March 2010

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Abstract

Type 2 diabetes mellitus (DM2) has been associated with hepatocellular carcinoma (HCC) development. To study this relationship, we enrolled 465 HCC patients compared with 618 Cirrhotic cases and 490 Controls. The prevalence of DM2 is significantly higher in HCC patients with an Odds

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Type 2 diabetes mellitus (DM2) has been associated with hepatocellular carcinoma (HCC) development. To study this relationship, we enrolled 465 HCC patients compared with 618 Cirrhotic cases and 490 Controls. The prevalence of DM2 is significantly higher in HCC patients with an Odds Ratio of 3.12 versus Controls. In HCC cases with alcohol abuse, the frequency of DM2 is the highest. In our HCC patients, when HCV infection is associated with alcohol abuse, the liver cancer develops earlier. In addition, multivariate analysis shows that alcohol consumption is an independent risk factor for HCC more relevant than HCV infection. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Alcohol Trajectories over Three Years in a Swedish Residence Hall Student Population

by Henriettae Ståhlbrandt, Anders Leifman, Kent O. Johnsson and Mats Berglund

Int. J. Environ. Res. Public Health 2010, 7(4), 1432-1447; doi:10.3390/ijerph7041432

Received: 8 January 2010 / Revised: 9 February 2010 / Accepted: 10 March 2010 / Published: 29 March 2010

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Abstract

Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits

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Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Can the Blood Alcohol Concentration Be a Predictor for Increased Hospital Complications in Trauma Patients Involved in Motor Vehicle Crashes?

by Jaime H. Kapur, Victoria Rajamanickam and Michael F. Fleming

Int. J. Environ. Res. Public Health 2010, 7(3), 1174-1185; doi:10.3390/ijerph7031174

Received: 8 February 2010 / Revised: 15 March 2010 / Accepted: 15 March 2010 / Published: 18 March 2010

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Abstract

The goal of this report is to assess the relationship of varying levels of blood alcohol concentration (BAC) and hospital complications in patients admitted after motor vehicle crashes. Data for the study was collected by a retrospective review of the University of Wisconsin

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The goal of this report is to assess the relationship of varying levels of blood alcohol concentration (BAC) and hospital complications in patients admitted after motor vehicle crashes. Data for the study was collected by a retrospective review of the University of Wisconsin Hospital trauma registry between 1999 and 2007 using the National Trauma Registry of the American College of Surgeons (NTRACS). Of 3729 patients, 2210 (59%) had a negative BAC, 338 (9%) <100 mg/dL, 538 (14%) 100–199 mg/dL, and 643 (17%) >200 mg/dL. Forty-six percent of patients had one or more hospital related complications. The odds ratio (OR) for the occurrence of alcohol withdrawal in the three alcohol groups compared to the no alcohol group was 12.02 (CI 7.0–20.7), 16.81 (CI 10.4–27.2), and 30.96 (CI 19.5–49.2) as BAC increased with a clear dose response effect. While there were no significant differences in the frequency of the total hospital events following trauma across the four groups, rates of infections, coagulopathies, central nervous system events and renal complications were lower in the high BAC group. Prospective studies are needed to more precisely estimate the frequency of hospital complications in patients with alcohol use disorders and in persons intoxicated at the time of the motor vehicle accident. The study supports the use of routine BAC to predict patients at high risk for alcohol withdrawal and the early initiation of alcohol detoxification. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Sudden Unexpected Death in Alcohol Misuse—An Unrecognized Public Health Issue?

by Alexa H. Templeton, Karen L. T. Carter, Nick Sheron, Patrick J. Gallagher and Clare Verrill

Int. J. Environ. Res. Public Health 2009, 6(12), 3070-3081; doi:10.3390/ijerph6123070

Received: 29 October 2009 / Accepted: 29 November 2009 / Published: 4 December 2009

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Abstract

Sudden arrhythmic cardiac death can occur in chronic misusers of alcohol. The only findings at post mortem are fatty liver and a negative or low blood alcohol. This is an under-recognized entity. Coroner‘s post mortems in a typical UK city were studied. Seven

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Sudden arrhythmic cardiac death can occur in chronic misusers of alcohol. The only findings at post mortem are fatty liver and a negative or low blood alcohol. This is an under-recognized entity. Coroner‘s post mortems in a typical UK city were studied. Seven out of 1,292 (0.5%) post mortems were deemed to have died of alcohol associated arrhythmic death. Applying this study to the UK as a whole, alcohol related arrhythmic death or as we have termed it SUDAM (Sudden Unexpected Death in Alcohol Misuse) probably accounts for around 1,000 deaths, many of which are misattributed to other causes Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Gender Differences in Interpersonal Problems of Alcohol-Dependent Patients and Healthy Controls

by Sandra E. Mueller, Bigna Degen, Sylvie Petitjean, Gerhard A. Wiesbeck and Marc Walter

Int. J. Environ. Res. Public Health 2009, 6(12), 3010-3022; doi:10.3390/ijerph6123010

Received: 6 November 2009 / Accepted: 26 November 2009 / Published: 1 December 2009

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Abstract

Alcohol dependence is a heavy burden on patients, their families, and society. Epidemiological studies indicate that alcohol dependence will affect many individuals at some time in their lives, with men affected more frequently than women. Since alcohol-dependent patients often exhibit a lack of

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Alcohol dependence is a heavy burden on patients, their families, and society. Epidemiological studies indicate that alcohol dependence will affect many individuals at some time in their lives, with men affected more frequently than women. Since alcohol-dependent patients often exhibit a lack of social skills and suffer from interpersonal problems, the aim of this study is to elucidate whether men and women experience the same interpersonal problems. Eighty-five alcohol-dependent patients (48 men; 37 women) after detoxification and 62 healthy controls (35 men; 27 women) were recruited. Interpersonal problems were measured with the Inventory of Interpersonal Problems (IIP-64). Additionally, alcohol-dependent patients were interviewed with the Alcohol Use Disorders Identification Test (AUDIT) and were subtyped according to Lesch’s Alcohol Typology (LAT). There were no significant gender differences in the AUDIT and LAT between alcohol-dependent men and women. Interpersonal problems of alcohol-dependent men differed significantly in one out of eight dimensions from controls; alcohol-dependent men perceive themselves as colder than male controls. Alcohol-dependent women differed in four out of eight interpersonal dimensions from female controls. Alcohol-dependent women rated themselves as significantly more vindictive, more introverted, more overly accommodating and more intrusive than female controls. Results suggest that alcohol-dependent men and women suffer from different interpersonal problems and furthermore alcohol-dependent women perceive more interpersonal problems, whereas the severity of alcohol dependence did not differ between the groups. Our findings indicate that alcohol-dependent women may profit more from a gender-specific treatment approach aimed at improving treatment outcome than alcohol-dependent men. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Examining Factors in the Research Institute on Addictions Self-Inventory (RIASI): Associations with Alcohol Use and Problems at Assessment and Follow-Up

by Robert E. Mann, Gina Stoduto, Rosely Flam Zalcman, Thomas H. Nochajski, Louise Hall, Patricia Dill and Elisabeth Wells-Parker

Int. J. Environ. Res. Public Health 2009, 6(11), 2898-2918; doi:10.3390/ijerph6112898

Received: 7 October 2009 / Accepted: 18 November 2009 / Published: 24 November 2009

Cited by 7 | PDF Full-text (269 KB) | HTML Full-text | XML Full-text

Abstract

Impaired driving is a leading cause of alcohol-related deaths and injuries. Rehabilitation or remedial programs, involving assessment and screening of convicted impaired drivers to determine problem severity and appropriate programs, are an important component of society’s response to this problem. Ontario’s remedial program,

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Impaired driving is a leading cause of alcohol-related deaths and injuries. Rehabilitation or remedial programs, involving assessment and screening of convicted impaired drivers to determine problem severity and appropriate programs, are an important component of society’s response to this problem. Ontario’s remedial program, Back on Track (BOT), involves an assessment process that includes administration of the Research Institute on Addictions Self-Inventory (RIASI) to determine assignment to an education or treatment program. The purpose of this study is to identify factors within the RIASI and examine how factor scores are associated with alcohol use and problem indicators at assessment and six-month follow-up. The sample included 22,298 individuals who completed BOT from 2000 to 2005. Principal component factor analysis with varimax rotation was conducted on RIASI data and an eight factor solution was retained: (1) Negative Affect, (2) Sensation Seeking, (3) Alcohol-Quantity, (4) Social Conformity, (5) High Risk Lifestyle, (6) Alcohol Problems, (7) Interpersonal Competence, and (8) Family History. Regression analyses were conducted to examine associations between factors and alcohol and problem measures obtained at assessment and at follow-up. Most factors, except for Interpersonal Competence, were associated with more alcohol use and problems at assessment. A similar pattern was observed at 6-month follow-up, but interestingly some factors (Negative Affect, Sensation Seeking, Alcohol-Quantity and Family History) predicted fewer days of alcohol use. The Interpersonal Competence factor was associated with significantly lower levels of alcohol use and problems at both assessment and follow-up. This work suggests that the RIASI provides information on several domains that have important relationships with alcohol problem severity and outcomes. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle A History of Alcohol Dependence Increases the Incidence and Severity of Postoperative Cognitive Dysfunction in Cardiac Surgical Patients

by Judith A. Hudetz, Kathleen M. Patterson, Alison J. Byrne, Zafar Iqbal, Sweeta D. Gandhi, David C. Warltier and Paul S. Pagel

Int. J. Environ. Res. Public Health 2009, 6(11), 2725-2739; doi:10.3390/ijerph6112725

Received: 27 August 2009 / Accepted: 17 October 2009 / Published: 27 October 2009

Cited by 8 | PDF Full-text (245 KB) | HTML Full-text | XML Full-text

Abstract

Postoperative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. We tested the hypothesis that a history of alcohol dependence is associated with an increased incidence and severity of POCD in male patients undergoing cardiac surgery using cardiopulmonary bypass. Recent verbal and nonverbal memory

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Postoperative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. We tested the hypothesis that a history of alcohol dependence is associated with an increased incidence and severity of POCD in male patients undergoing cardiac surgery using cardiopulmonary bypass. Recent verbal and nonverbal memory and executive functions were assessed before and one week after surgery in patients with or without a history of alcohol dependence. Cognitive function was significantly reduced after cardiac surgery in patients with versus without a history of alcohol dependence. The results suggest that a history of alcohol dependence increases the incidence and severity of POCD after cardiac surgery. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle A Multicenter, Randomized, Open-Labeled, Parallel Group Trial of Sildenafil in Alcohol-Associated Erectile Dysfunction: The Impact on Psychosocial Outcomes

by Alexander M. Ponizovsky, Lev Averbuch, Ira Radomislensky and Alexander Grinshpoon

Int. J. Environ. Res. Public Health 2009, 6(9), 2510-2525; doi:10.3390/ijerph6092510

Received: 13 August 2009 / Accepted: 22 September 2009 / Published: 23 September 2009

Cited by 2 | PDF Full-text (262 KB) | HTML Full-text | XML Full-text

Abstract

To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without

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To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF) and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001). The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Alcohol Consumption and Development of Acute Respiratory Distress Syndrome: A Population-Based Study

by Lokendra Thakur, Marija Kojicic, Sweta J. Thakur, Matthew S. Pieper, Rahul Kashyap, Cesar A. Trillo-Alvarez, Fernandez Javier, Rodrigo Cartin-Ceba and Ognjen Gajic

Int. J. Environ. Res. Public Health 2009, 6(9), 2426-2435; doi:10.3390/ijerph6092426

Received: 11 August 2009 / Accepted: 4 September 2009 / Published: 10 September 2009

Cited by 11 | PDF Full-text (85 KB) | HTML Full-text | XML Full-text

Abstract

This retrospective population-based study evaluated the effects of alcohol consumption on the development of acute respiratory distress syndrome (ARDS). Alcohol consumption was quantified based on patient and/or family provided information at the time of hospital admission. ARDS was defined according to American-European consensus

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This retrospective population-based study evaluated the effects of alcohol consumption on the development of acute respiratory distress syndrome (ARDS). Alcohol consumption was quantified based on patient and/or family provided information at the time of hospital admission. ARDS was defined according to American-European consensus conference (AECC). From 1,422 critically ill Olmsted county residents, 1,357 had information about alcohol use in their medical records, 77 (6%) of whom developed ARDS. A history of significant alcohol consumption (more than two drinks per day) was reported in 97 (7%) of patients. When adjusted for underlying ARDS risk factors (aspiration, chemotherapy, high-risk surgery, pancreatitis, sepsis, shock), smoking, cirrhosis and gender, history of significant alcohol consumption was associated with increased risk of ARDS development (odds ratio 2.9, 95% CI 1.3–6.2). This population-based study confirmed that excessive alcohol consumption is associated with higher risk of ARDS. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Motivations for Alcohol Use among Men Aged 16-30 Years in Sri Lanka

by Bilesha Perera and Mohammad Torabi

Int. J. Environ. Res. Public Health 2009, 6(9), 2408-2416; doi:10.3390/ijerph6092408

Received: 10 August 2009 / Accepted: 3 September 2009 / Published: 8 September 2009

Cited by 6 | PDF Full-text (145 KB) | HTML Full-text | XML Full-text

Abstract

Psychometric properties of a new scale that measures motivations towards alcohol use were examined using a sample of 412 male alcohol users in Sri Lanka aged 16-30 years. In addition, associations between drinking motives and drinking frequency were explored. Confirmatory factor analysis showed

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Psychometric properties of a new scale that measures motivations towards alcohol use were examined using a sample of 412 male alcohol users in Sri Lanka aged 16-30 years. In addition, associations between drinking motives and drinking frequency were explored. Confirmatory factor analysis showed that a 3-factor model consisting of the factors personal enjoyment, tension reduction, and social pressure fit the data well. Overall, tension-reduction motivation was found to be prominent in the context of young males’ drinking behavior in Sri Lanka. Associations between stress and alcohol use among young males warrant further investigations. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Verification of the Addiction Severity Index Japanese Version (ASI-J) as a Treatment-Customization, Prediction, and Comparison Tool for Alcohol-Dependent Individuals

by Ayako Haraguchi, Yasukazu Ogai, Eiichi Senoo, Satoru Saito, Yoshihiro Suzuki, Aihide Yoshino, Aro Ino, Kenji Yanbe, Mitsuru Hasegawa, Masaru Murakami, Masanobu Murayama, Toru Ishikawa, Susumu Higuchi and Kazutaka Ikeda

Int. J. Environ. Res. Public Health 2009, 6(8), 2205-2225; doi:10.3390/ijerph6082205

Received: 7 July 2009 / Accepted: 10 August 2009 / Published: 12 August 2009

Cited by 5 | PDF Full-text (558 KB) | HTML Full-text | XML Full-text

Abstract

Objective: To demonstrate the usefulness of the Addiction Severity Index Japanese Version (ASI-J) in Japanese alcohol-dependent individuals. The ASI is a frequently used clinical and research instrument that measures severities in seven functional domains in people with substance abuse disorders. Methods: A total

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Objective: To demonstrate the usefulness of the Addiction Severity Index Japanese Version (ASI-J) in Japanese alcohol-dependent individuals. The ASI is a frequently used clinical and research instrument that measures severities in seven functional domains in people with substance abuse disorders. Methods: A total of 370 male inpatients with a history of alcohol dependence participated in the study. Forty-nine participants were excluded in the final analysis due to lack of reliability (i.e., patient misrepresentation or inability to understand). We used the ASI-J and a series of indexes that determined patient states during and post-treatment. Results: The correlations between ASI Composite Scores (CSs), which were calculated through a weighted formula and indicated the severity of each problem area, were significant but low in eight relations and not significant in 13 relations, indicating substantial independence of the problem areas. Significant differences were found in Family/Social CSs between abstinent and relapsed alcohol-dependent individuals. The questions of undesirable attitude were significantly related to the CSs of Employment, Drug use, Family/Social, and Psychiatric sections. Significant differences were observed in patient demographics, CS, and ASI Severity Rating (SR) and interviewer’s subjective scoring between alcohol-dependent individuals and drug abusers. CSs in Japanese alcohol-dependent individuals were generally similar to corresponding CSs in individuals from other countries, with the exception of The Netherlands. Conclusions: This study demonstrated that the ASI-J is useful for understanding individual profiles of problems for each patient and planning customized treatment. The ASI-J served as a predictive tool for relapse and compliance to treatment afterward and was shown to be useful as a comparison tool in clarifying similarities and differences between substance abuser groups. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Ethanol Consumption by Wistar Rat Dams Affects Selenium Bioavailability and Antioxidant Balance in Their Progeny

by María Luisa Ojeda, Beatriz Vázquez, Fátima Nogales, María Luisa Murillo and Olimpia Carreras

Int. J. Environ. Res. Public Health 2009, 6(8), 2139-2149; doi:10.3390/ijerph6082139

Received: 3 July 2009 / Accepted: 22 July 2009 / Published: 30 July 2009

Cited by 12 | PDF Full-text (213 KB) | HTML Full-text | XML Full-text

Abstract

Ethanol consumption affects maternal nutrition, the mothers’ antioxidant balance and the future health of their progeny. Selenium (Se) is a trace element cofactor of the enzyme glutathione peroxidase (GPx). We will study the effect of ethanol on Se bioavailability in dams and in

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Ethanol consumption affects maternal nutrition, the mothers’ antioxidant balance and the future health of their progeny. Selenium (Se) is a trace element cofactor of the enzyme glutathione peroxidase (GPx). We will study the effect of ethanol on Se bioavailability in dams and in their progeny. We have used three experimental groups of dams: control, chronic ethanol and pair-fed; and three groups of pups. Se levels were measured by graphite-furnace atomic absorption spectrometry. Serum and hepatic GPx activity was determined by spectrometry. We have concluded that ethanol decreased Se retention in dams, affecting their tissue Se deposits and those of their offspring, while also compromising their progeny’s weight and oxidation balance. These effects of ethanol are caused by a reduction in Se intake and a direct alcohol-generated oxidation action. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle The Quality of Alcohol Products in Vietnam and Its Implications for Public Health

by Dirk W. Lachenmeier, Pham Thi Hoang Anh, Svetlana Popova and Jürgen Rehm

Int. J. Environ. Res. Public Health 2009, 6(8), 2090-2101; doi:10.3390/ijerph6082090

Received: 17 June 2009 / Accepted: 20 July 2009 / Published: 27 July 2009

Cited by 27 | PDF Full-text (338 KB) | HTML Full-text | XML Full-text

Abstract

Four homemade (artisanally manufactured and unrecorded) and seven commercial (industrially manufactured and taxed) alcohol products from Vietnam were collected and chemically analyzed for toxicologically relevant substances. The majority of both types had alcohol contents between 30 and 40% vol. Two homemade samples contained

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Four homemade (artisanally manufactured and unrecorded) and seven commercial (industrially manufactured and taxed) alcohol products from Vietnam were collected and chemically analyzed for toxicologically relevant substances. The majority of both types had alcohol contents between 30 and 40% vol. Two homemade samples contained significantly higher concentrations of 45 and 50% vol. In one of these homemade samples the labeled alcoholic strength was exceeded by nearly 20% vol. All other analyzed constituents of the samples (e.g., methanol, acetaldehyde, higher alcohols, esters, metals, anions) were found in concentrations that did not pose a threat to public health. A peculiarity was a homemade sample of alcohol with pickled snakes and scorpions that contained 77% vol of alcohol, allegedly used as traditional Chinese medicine. Based on this small sample, there is insufficient evidence to conclude that alcohol quality, beyond the effects of ethanol, has an influence on health in Vietnam. However, future research with larger samples is needed. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle The Liver-Brain Axis of Alcohol-Mediated Neurodegeneration: Role of Toxic Lipids

by Suzanne M. De la Monte, Lisa Longato, Ming Tong, Sarah DeNucci and Jack R. Wands

Int. J. Environ. Res. Public Health 2009, 6(7), 2055-2075; doi:10.3390/ijerph6072055

Received: 24 June 2009 / Accepted: 16 July 2009 / Published: 23 July 2009

Cited by 48 | PDF Full-text (762 KB) | HTML Full-text | XML Full-text

Abstract

Alcohol abuse causes progressive toxicity and degeneration in liver and brain due to insulin resistance, which exacerbates oxidative stress and pro-inflammatory cytokine activation. Alcohol-induced steatohepatitis promotes synthesis and accumulation of ceramides and other toxic lipids that cause insulin resistance. Ceramides can readily cross

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Alcohol abuse causes progressive toxicity and degeneration in liver and brain due to insulin resistance, which exacerbates oxidative stress and pro-inflammatory cytokine activation. Alcohol-induced steatohepatitis promotes synthesis and accumulation of ceramides and other toxic lipids that cause insulin resistance. Ceramides can readily cross the blood-brain barrier, and ceramide exposure causes neurodegeneration with insulin resistance and oxidative stress, similar to the effects of alcohol. Therefore, in addition to its direct neurotoxic effects, alcohol misuse establishes a liver-brain axis of neurodegeneration mediated by toxic lipid trafficking across the blood-brain barrier, leading to progressive white matter degeneration and cognitive impairment. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Silent Trace Eliminates Differential Eyeblink Learning in Abstinent Alcoholics

by Catherine Brawn Fortier, Arkadiy L. Maksimovskiy, Jonathan R. Venne, Ginette LaFleche and Regina E. McGlinchey

Int. J. Environ. Res. Public Health 2009, 6(7), 2007-2027; doi:10.3390/ijerph6072007

Received: 19 June 2009 / Accepted: 10 July 2009 / Published: 20 July 2009

Cited by 7 | PDF Full-text (435 KB) | HTML Full-text | XML Full-text

Abstract

Chronic alcoholism has profound effects on the brain, including volume reductions in regions critical for eyeblink classical conditioning (EBCC). The current study challenged abstinent alcoholics using delay (n = 20) and trace (n = 17) discrimination/reversal EBCC. Comparisons revealed a significant difference between

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Chronic alcoholism has profound effects on the brain, including volume reductions in regions critical for eyeblink classical conditioning (EBCC). The current study challenged abstinent alcoholics using delay (n = 20) and trace (n = 17) discrimination/reversal EBCC. Comparisons revealed a significant difference between delay and trace conditioning performance during reversal (t (35) = 2.08, p < 0.05). The difference between the two tasks for discrimination was not significant (p = 0.44). These data support the notion that alcoholics are increasingly impaired in the complex task of reversing a previously learned discrimination when a silent trace interval is introduced. Alcoholics’ impairment in flexibly altering learned associations may be central to their continued addiction. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessArticle Prevalence of Alcohol Consumption and Hazardous Drinking, Tobacco and Drug Use in Urban Tanzania, and Their Associated Risk Factors

by Joseph Mbatia, Rachel Jenkins, Nicola Singleton and Bethany White

Int. J. Environ. Res. Public Health 2009, 6(7), 1991-2006; doi:10.3390/ijerph6071991

Received: 4 June 2009 / Accepted: 9 July 2009 / Published: 16 July 2009

Cited by 29 | PDF Full-text (253 KB) | HTML Full-text | XML Full-text

Abstract

Evidence suggests substance abuse in Tanzania is a growing public health problem. A random sample of 899 adults aged 15-59 in two urban sites of differing levels of poverty surveyed alcohol, tobacco and illicit substance use. Rates of substance use were 17.2%. 8.7%

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Evidence suggests substance abuse in Tanzania is a growing public health problem. A random sample of 899 adults aged 15-59 in two urban sites of differing levels of poverty surveyed alcohol, tobacco and illicit substance use. Rates of substance use were 17.2%. 8.7% and 0.8% for alcohol, tobacco and cannabis, respectively. Living in the less affluent area was associated with higher lifetime rates of tobacco and alcohol use. Substance use is less prevalent in Tanzania than in richer countries, but lifetime consumption is higher in poorer areas. The association of substance use with a range of socio-economic factors warrants further research. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Hazards Faced by Young Designated Drivers: In-Car Risks of Driving Drunken Passengers

by Peter J. Rothe and Linda J. Carroll

Int. J. Environ. Res. Public Health 2009, 6(6), 1760-1777; doi:10.3390/ijerph6061760

Received: 18 May 2009 / Accepted: 5 June 2009 / Published: 8 June 2009

Cited by 7 | PDF Full-text (372 KB) | HTML Full-text | XML Full-text

Abstract

This qualitative study explored the risk in the practice of young designated drivers transporting drunken peers. Young drivers 18-29 years old in Alberta, Canada participated in 12 focus groups (N = 146). Interviews were semi-structured. A key finding is that when highly intoxicated

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This qualitative study explored the risk in the practice of young designated drivers transporting drunken peers. Young drivers 18-29 years old in Alberta, Canada participated in 12 focus groups (N = 146). Interviews were semi-structured. A key finding is that when highly intoxicated youth are driven by a designated driver who is a peer, they are likely to behave in ways that are unsafe. Unsafe actions of drunken passengers in the vehicle include physical “rough-housing” with the driver, creating stress for the driver that leads to high risk driving situations and disrupting safe driving through nausea and in-car vomiting. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Review

Jump to: Research

Open AccessReview A Literature Review of Cost-Benefit Analyses for the Treatment of Alcohol Dependence

by Svetlana Popova, Satya Mohapatra, Jayadeep Patra, Amy Duhig and Jürgen Rehm

Int. J. Environ. Res. Public Health 2011, 8(8), 3351-3364; doi:10.3390/ijerph8083351

Received: 7 June 2011 / Revised: 3 August 2011 / Accepted: 3 August 2011 / Published: 16 August 2011

Cited by 10 | PDF Full-text (224 KB) | HTML Full-text | XML Full-text

Abstract

The purpose of this study was to conduct a literature review of cost-benefit studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD). A literature search was performed in multiple electronic bibliographic databases. The search identified seven psychotherapy studies from the USA and

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The purpose of this study was to conduct a literature review of cost-benefit studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD). A literature search was performed in multiple electronic bibliographic databases. The search identified seven psychotherapy studies from the USA and two pharmacotherapy studies from Europe. In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Alcohol Consumption and Oxidative DNA Damage

by Takeshi Hirano

Int. J. Environ. Res. Public Health 2011, 8(7), 2895-2906; doi:10.3390/ijerph8072895

Received: 1 June 2011 / Revised: 5 July 2011 / Accepted: 6 July 2011 / Published: 14 July 2011

Cited by 7 | PDF Full-text (450 KB) | HTML Full-text | XML Full-text

Abstract

To examine the effects of alcohol consumption on cancer risk, we measured oxidative DNA damage and its repair activity in the livers and esophagi of rats fed with ethanol. Using our previously designed protocol for feeding rats with a high concentration of ethanol,

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To examine the effects of alcohol consumption on cancer risk, we measured oxidative DNA damage and its repair activity in the livers and esophagi of rats fed with ethanol. Using our previously designed protocol for feeding rats with a high concentration of ethanol, we examined the effects of ethanol consumption on 8-oxo-Gua generation and repair activity in the livers and esophagi of rats. We found that a high concentration of ethanol accompanied with a vitamin-depleted diet increased 8-oxo-Gua and its repair activity. 8-Oxo-Gua is known to induce point mutations, leading to carcinogenesis. Therefore, these results suggested that a high concentration of ethanol and an irregular diet increased liver and esophageal cancer risk. On the other hand, we showed that a low concentration of ethanol decreased 8-oxo-Gua and its repair activity in the livers of mice treated with a carcinogen. Taken together, the effects of ethanol consumption on cancer risk depend on the ethanol concentration and the diet pattern. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Genetic Risk for Alcoholic Chronic Pancreatitis

by Marianges Zadrozny Gouvêa da Costa, Dulce Reis Guarita, Suzane Kioko Ono-Nita, Denise Cerqueira Paranaguá-Vezozzo, Guilherme Eduardo Gonçalves Felga, Martha Regina Arcon Pedroso, Marcelo Moreira Tavares de Souza, Paulo Dominguez Nasser, Camila Da Silva Ferreira and Flair José Carrilho

Int. J. Environ. Res. Public Health 2011, 8(7), 2747-2757; doi:10.3390/ijerph8072747

Received: 7 June 2011 / Accepted: 20 June 2011 / Published: 30 June 2011

Cited by 11 | PDF Full-text (165 KB) | HTML Full-text | XML Full-text

Abstract

In recent years many studies have examined the genetic predisposition to pancreatic diseases. Pancreatic disease of an alcoholic etiology was determined to be a multi-factorial disease, where environmental factors interact with the genetic profile of the individual. In this review we discuss the

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In recent years many studies have examined the genetic predisposition to pancreatic diseases. Pancreatic disease of an alcoholic etiology was determined to be a multi-factorial disease, where environmental factors interact with the genetic profile of the individual. In this review we discuss the main results from studies examining the frequency of genetic mutations in alcoholic chronic pancreatitis. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Molecular Basis and Current Treatment for Alcoholic Liver Disease

by Alejandra Miranda-Mendez, Alejandro Lugo-Baruqui and Juan Armendariz-Borunda

Int. J. Environ. Res. Public Health 2010, 7(5), 1872-1888; doi:10.3390/ijerph7051872

Received: 18 February 2010 / Accepted: 5 March 2010 / Published: 27 April 2010

Cited by 27 | PDF Full-text (408 KB) | HTML Full-text | XML Full-text

Abstract

Alcohol use disorders and alcohol dependency affect millions of individuals worldwide. The impact of these facts lies in the elevated social and economic costs. Alcoholic liver disease is caused by acute and chronic exposure to ethanol which promotes oxidative stress and inflammatory response.

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Alcohol use disorders and alcohol dependency affect millions of individuals worldwide. The impact of these facts lies in the elevated social and economic costs. Alcoholic liver disease is caused by acute and chronic exposure to ethanol which promotes oxidative stress and inflammatory response. Chronic consumption of ethanol implies liver steatosis, which is the first morphological change in the liver, followed by liver fibrosis and cirrhosis. This review comprises a broad approach of alcohol use disorders, and a more specific assessment of the pathophysiologic molecular basis, and genetics, as well as clinical presentation and current modalities of treatment for alcoholic liver disease. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Ethanol and Cognition: Indirect Effects, Neurotoxicity and Neuroprotection: A Review

by John C.M. Brust

Int. J. Environ. Res. Public Health 2010, 7(4), 1540-1557; doi:10.3390/ijerph7041540

Received: 8 February 2010 / Accepted: 1 April 2010 / Published: 4 April 2010

Cited by 65 | PDF Full-text (315 KB) | HTML Full-text | XML Full-text

Abstract

Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder. Additionally, ethanol is a direct neurotoxin and in sufficient dosage

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Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder. Additionally, ethanol is a direct neurotoxin and in sufficient dosage can cause lasting dementia. However, ethanol also has neuroprotectant properties and in low-to-moderate dosage reduces the risk of dementia, including Alzheimer type. In fetuses ethanol is teratogenic, and whether there exists a safe dose during pregnancy is uncertain and controversial. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Alcohol and Acetaldehyde in Public Health: From Marvel to Menace

by Rui Guo and Jun Ren

Int. J. Environ. Res. Public Health 2010, 7(4), 1285-1301; doi:10.3390/ijerph7041285

Received: 11 January 2010 / Revised: 23 February 2010 / Accepted: 12 March 2010 / Published: 25 March 2010

Cited by 49 | PDF Full-text (148 KB) | HTML Full-text | XML Full-text

Abstract

Alcohol abuse is a serious medical and social problem. Although light to moderate alcohol consumption is beneficial to cardiovascular health, heavy drinking often results in organ damage and social problems. In addition, genetic susceptibility to the effect of alcohol on cancer and coronary

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Alcohol abuse is a serious medical and social problem. Although light to moderate alcohol consumption is beneficial to cardiovascular health, heavy drinking often results in organ damage and social problems. In addition, genetic susceptibility to the effect of alcohol on cancer and coronary heart disease differs across the population. A number of mechanisms including direct the toxicity of ethanol, its metabolites [e.g., acetaldehyde and fatty acid ethyl esters (FAEEs)] and oxidative stress may mediate alcoholic complications. Acetaldehyde, the primary metabolic product of ethanol, is an important candidate toxin in developing alcoholic diseases. Meanwhile, free radicals produced during ethanol metabolism and FAEEs are also important triggers for alcoholic damages. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview A New View of Alcohol Metabolism and Alcoholism—Role of the High-K_m Class Ⅲ Alcohol Dehydrogenase (ADH3)

by Takeshi Haseba and Youkichi Ohno

Int. J. Environ. Res. Public Health 2010, 7(3), 1076-1092; doi:10.3390/ijerph7031076

Received: 4 January 2010 / Revised: 12 February 2010 / Accepted: 22 February 2010 / Published: 15 March 2010

Cited by 21 | PDF Full-text (287 KB) | HTML Full-text | XML Full-text

Abstract

The conventional view is that alcohol metabolism is carried out by ADH1 (Class I) in the liver. However, it has been suggested that another pathway plays an important role in alcohol metabolism, especially when the level of blood ethanol is high or when

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The conventional view is that alcohol metabolism is carried out by ADH1 (Class I) in the liver. However, it has been suggested that another pathway plays an important role in alcohol metabolism, especially when the level of blood ethanol is high or when drinking is chronic. Over the past three decades, vigorous attempts to identify the enzyme responsible for the non-ADH1 pathway have focused on the microsomal ethanol oxidizing system (MEOS) and catalase, but have failed to clarify their roles in systemic alcohol metabolism. Recently, using ADH3-null mutant mice, we demonstrated that ADH3 (Class III), which has a high K_m and is a ubiquitous enzyme of ancient origin, contributes to systemic alcohol metabolism in a dose-dependent manner, thereby diminishing acute alcohol intoxication. Although the activity of ADH3 toward ethanol is usually low in vitro due to its very high K_m, the catalytic efficiency (k_cat/K_m) is markedly enhanced when the solution hydrophobicity of the reaction medium increases. Activation of ADH3 by increasing hydrophobicity should also occur in liver cells; a cytoplasmic solution of mouse liver cells was shown to be much more hydrophobic than a buffer solution when using Nile red as a hydrophobicity probe. When various doses of ethanol are administered to mice, liver ADH3 activity is dynamically regulated through induction or kinetic activation, while ADH1 activity is markedly lower at high doses (3–5 g/kg). These data suggest that ADH3 plays a dynamic role in alcohol metabolism, either collaborating with ADH1 or compensating for the reduced role of ADH1. A complex two-ADH model that ascribes total liver ADH activity to both ADH1 and ADH3 explains the dose-dependent changes in the pharmacokinetic parameters (b, CL_T, AUC) of blood ethanol very well, suggesting that alcohol metabolism in mice is primarily governed by these two ADHs. In patients with alcoholic liver disease, liver ADH3 activity increases, while ADH1 activity decreases, as alcohol intake increases. Furthermore, ADH3 is induced in damaged cells that have greater hydrophobicity, whereas ADH1 activity is lower when there is severe liver disease. These data suggest that chronic binge drinking and the resulting liver disease shifts the key enzyme in alcohol metabolism from low-K_m ADH1 to high-K_m ADH3, thereby reducing the rate of alcohol metabolism. The interdependent increase in the ADH3/ADH1 activity ratio and AUC may be a factor in the development of alcoholic liver disease. However, the adaptive increase in ADH3 sustains alcohol metabolism, even in patients with alcoholic liver cirrhosis, which makes it possible for them to drink themselves to death. Thus, the regulation of ADH3 activity may be important in preventing alcoholism development. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Biological Contribution to Social Influences on Alcohol Drinking: Evidence from Animal Models

by Allison M.J. Anacker and Andrey E. Ryabinin

Int. J. Environ. Res. Public Health 2010, 7(2), 473-493; doi:10.3390/ijerph7020473

Received: 31 December 2009 / Accepted: 8 February 2010 / Published: 11 February 2010

Cited by 26 | PDF Full-text (149 KB) | HTML Full-text | XML Full-text

Abstract

Social factors have a tremendous influence on instances of heavy drinking and in turn impact public health. However, it is extremely difficult to assess whether this influence is only a cultural phenomenon or has biological underpinnings. Research in non-human primates demonstrates that the

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Social factors have a tremendous influence on instances of heavy drinking and in turn impact public health. However, it is extremely difficult to assess whether this influence is only a cultural phenomenon or has biological underpinnings. Research in non-human primates demonstrates that the way individuals are brought up during early development affects their future predisposition for heavy drinking, and research in rats demonstrates that social isolation, crowding or low social ranking can lead to increased alcohol intake, while social defeat can decrease drinking. Neurotransmitter mechanisms contributing to these effects (i.e., serotonin, GABA, dopamine) have begun to be elucidated. However, these studies do not exclude the possibility that social effects on drinking occur through generalized stress responses to negative social environments. Alcohol intake can also be elevated in positive social situations, for example, in rats following an interaction with an intoxicated peer. Recent studies have also begun to adapt a new rodent species, the prairie vole, to study the role of social environment in alcohol drinking. Prairie voles demonstrate a high degree of social affiliation between individuals, and many of the neurochemical mechanisms involved in regulation of these social behaviors (for example, dopamine, central vasopressin and the corticotropin releasing factor system) are also known to be involved in regulation of alcohol intake. Naltrexone, an opioid receptor antagonist approved as a pharmacotherapy for alcoholic patients, has recently been shown to decrease both partner preference and alcohol preference in voles. These findings strongly suggest that mechanisms by which social factors influence drinking have biological roots, and can be studied using rapidly developing new animal models. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment

by Asher Ornoy and Zivanit Ergaz

Int. J. Environ. Res. Public Health 2010, 7(2), 364-379; doi:10.3390/ijerph7020364

Received: 16 December 2009 / Accepted: 22 January 2010 / Published: 27 January 2010

Cited by 53 | PDF Full-text (135 KB) | HTML Full-text | XML Full-text

Abstract

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the

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Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies. With lower repetitive doses there is a risk of "alcoholic effects" mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency. It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care. The long term intellectual outcome of children born to ethanol dependent mothers is influenced to a large extent by the environment in which the exposed child is raised. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Deadly Partners: Interdependence of Alcohol and Trauma in the Clinical Setting

by Amanda V. Hayman and Marie L. Crandall

Int. J. Environ. Res. Public Health 2009, 6(12), 3097-3104; doi:10.3390/ijerph6123097

Received: 23 October 2009 / Accepted: 2 December 2009 / Published: 4 December 2009

Cited by 7 | PDF Full-text (175 KB) | HTML Full-text | XML Full-text

Abstract

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as

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Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Alcohol-Induced Blackout

by Hamin Lee, Sungwon Roh and Dai Jin Kim

Int. J. Environ. Res. Public Health 2009, 6(11), 2783-2792; doi:10.3390/ijerph6112783

Received: 10 October 2009 / Accepted: 5 November 2009 / Published: 6 November 2009

Cited by 22 | PDF Full-text (108 KB) | HTML Full-text | XML Full-text

Abstract

For a long time, alcohol was thought to exert a general depressant effect on the central nervous system (CNS). However, currently the consensus is that specific regions of the brain are selectively vulnerable to the acute effects of alcohol. An alcohol-induced blackout is

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For a long time, alcohol was thought to exert a general depressant effect on the central nervous system (CNS). However, currently the consensus is that specific regions of the brain are selectively vulnerable to the acute effects of alcohol. An alcohol-induced blackout is the classic example; the subject is temporarily unable to form new long-term memories while relatively maintaining other skills such as talking or even driving. A recent study showed that alcohol can cause retrograde memory impairment, that is, blackouts due to retrieval impairments as well as those due to deficits in encoding. Alcoholic blackouts may be complete (en bloc) or partial (fragmentary) depending on severity of memory impairment. In fragmentary blackouts, cueing often aids recall. Memory impairment during acute intoxication involves dysfunction of episodic memory, a type of memory encoded with spatial and social context. Recent studies have shown that there are multiple memory systems supported by discrete brain regions, and the acute effects of alcohol on learning and memory may result from alteration of the hippocampus and related structures on a cellular level. A rapid increase in blood alcohol concentration (BAC) is most consistently associated with the likelihood of a blackout. However, not all subjects experience blackouts, implying that genetic factors play a role in determining CNS vulnerability to the effects of alcohol. This factor may predispose an individual to alcoholism, as altered memory function during intoxication may affect an individual‟s alcohol expectancy; one may perceive positive aspects of intoxication while unintentionally ignoring the negative aspects. Extensive research on memory and learning as well as findings related to the acute effects of alcohol on the brain may elucidate the mechanisms and impact associated with the alcohol- induced blackout. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Alcoholic Pancreatitis: Pathogenesis, Incidence and Treatment with Special Reference to the Associated Pain

by Raffaele Pezzilli and Antonio M. Morselli-Labate

Int. J. Environ. Res. Public Health 2009, 6(11), 2763-2782; doi:10.3390/ijerph6112763

Received: 17 September 2009 / Accepted: 2 November 2009 / Published: 4 November 2009

Cited by 7 | PDF Full-text (328 KB) | HTML Full-text | XML Full-text

Abstract

Alcoholic pancreatitis continues to stir up controversy. One of the most debated points is whether from onset it is a chronic disease or whether it progresses to a chronic form after repeated episodes of acute pancreatitis. Histological studies on patients with alcoholic pancreatitis

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Alcoholic pancreatitis continues to stir up controversy. One of the most debated points is whether from onset it is a chronic disease or whether it progresses to a chronic form after repeated episodes of acute pancreatitis. Histological studies on patients with alcoholic pancreatitis have shown that the disease is chronic from onset and that alcoholic acute pancreatitis occurs in a pancreas already damaged by chronic lesions. Genetic factors may also play a role in the pathogenesis of alcoholic disease. The incidence of chronic alcoholic pancreatitis seems to have decreased in the last twenty years. Finally, recent therapeutic studies which have shown medical or surgical approaches capable of reducing the pain episodes in chronic pancreatitis patients will be described. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Gamma Hydroxybutyric Acid (GHB) for the Treatment of Alcohol Dependence: A Review

by Fabio Caputo, Teo Vignoli, Icro Maremmani, Mauro Bernardi and Giorgio Zoli

Int. J. Environ. Res. Public Health 2009, 6(6), 1917-1929; doi:10.3390/ijerph6061917

Received: 15 May 2009 / Accepted: 21 June 2009 / Published: 24 June 2009

Cited by 45 | PDF Full-text (248 KB) | HTML Full-text | XML Full-text

Abstract

Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid structurally similar to the inhibitory neurotransmitter γ-aminobutyric acid. Clinical trials have demonstrated that 50-100 mg/kg of GHB fractioned into three or six daily doses is able to suppress alcohol withdrawal symptoms and facilitates the maintenance

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Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid structurally similar to the inhibitory neurotransmitter γ-aminobutyric acid. Clinical trials have demonstrated that 50-100 mg/kg of GHB fractioned into three or six daily doses is able to suppress alcohol withdrawal symptoms and facilitates the maintenance of abstinence from alcohol. These studies have also shown that GHB craving episodes are a very limited phenomenon (about 10-15%). Thus, physicians with access should consider the clinical efficacy of GHB as a valid pharmacological tool for the treatment of alcohol addiction. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Guest Editor Prof. Dr. David J. Hanson State University of New York College at Potsdam, Department of Sociology, 112 Breckenridge Place, Chapel Hill, NC 27514, USA Website \| E-Mail Interests: impact of drinking beverage alcohol on health; effective ways to reduce alcohol abuse in a population
Editorial Advisor Dr. Joris Cornelis Verster Utrecht University, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands E-Mail Fax: +31 30 253 7900 Interests: effects of drugs on driving and traffic safety; drug abuse and addiction; sleep and sleep disorders