Substance Abuse News

Social factors have consistently been implicated as a cause of vulnerability to alcohol use and abuse. The reverse is also true, in that individuals who engage in excessive drinking may alter their social context. New research on drinking among older adults has found that older adults who have more money, engage in more social activities, and whose friends approve more of drinking are more likely to engage in excessive or high-risk drinking.

Results will be published in the April 2010 issue of Alcoholism: Clinical & Experimental Research.

“Ours is one of the first studies to focus longitudinally on high-risk drinking among older adults,” said Rudolf H. Moos, senior research career scientist for the Department of Veterans Affairs Health Care System in Palo Alto, California, as well as corresponding author for the study, “and the first to have 10-year and 20-year follow-ups addressing this issue.”

Social and Financial Influences

Moos and his colleagues examined 719 (399 men, 320 women) 55 to 65-year-old adults at baseline (between 1986-1988), and then again 10 and 20 years later. At each contact point, participants provided information regarding their drinking, as well as their social and financial resources.

“Our findings show that, one, certain social factors may enhance the chances of an individual engaging in high-risk drinking and, two, once high-risk drinking has developed, social choices may be made to facilitate continuing this behavior,” said Moos.

More specifically, results showed that older adults who have more money, who engage in more social activities, and whose friends approve more of drinking are more likely to engage in what is considered high-risk drinking: more than three drinks per day or more than 14 drinks per week.

“These findings show that social contextual models of alcohol use apply to older drinkers,” observed Charles J. Holahan, a professor in the department of psychology at The University of Texas at Austin. “The findings undercut the assumption of a solely dispositional view of drinking among older adults, whose alcohol use might easily be assumed to be outside the sway of social influences after a lifetime of drinking. They also provide a textured picture of two processes that link social context and alcohol misuse in a reciprocal way—social causation, whereby social context shapes alcohol use, and social selection, whereby alcohol use in turn shapes social context.”

“Older adults who engage in high-risk alcohol consumption tend to select friends who are more likely to drink and to approve of drinking,” said Moos. “They may also experience a decline in the quality of relationships with extended family members, that is, high-risk drinking may impair some family relationships. Compared to older women, older men may be more vulnerable or susceptible to some social influences on drinking. Specifically, having more money, and friends who approve more of drinking, seem to be more closely related to high-risk drinking among older men than among older women.”

Alcohol Problems Don’t Go Away

“The findings serve to undercut a solely person-blame approach to later life drinking,” said Holahan. “They demonstrate that a spouse and friends can make a constructive difference in later life drinking. However, a spouse and friends can also unwittingly become caught up as facilitators in the process of later life drinking. The findings also encourage awareness that alcohol misuse does not go away with aging. Although alcohol consumption declined with aging, at the 20-year follow-up more than 20 percent of adults aged 75 to 85 still engaged in high-risk alcohol consumption.”

“This information can be used to teach older adults, and family members and friends who care about and have some responsibility for them, about how to avoid or minimize ‘triggers,’ such as specific social activities or interactions with friends associated with heavy drinking,” said Moos. “While this type of information might be useful for brief interventions for older adults in primary care or community settings, there is no inherent reason why family members and friends of older adults who engage in excessive drinking could not use it.”

A team of scientists from The Scripps Research Institute has found that a specific stress hormone, the corticotropin-releasing factor (CRF), is key to the development and maintenance of alcohol dependence in animal models. Chemically blocking the stress factor also blocked the signs and symptoms of addiction, suggesting a potentially promising area for future drug development.

The article, the culmination of more than six years of research, will appear in an upcoming print edition of the journal Biological Psychiatry.

“I’m excited about this study,” said Associate Professor Marisa Roberto, who led the research. “It represents an important step in understanding how the brain changes when it moves from a normal to an alcohol-dependent state.”

The new study not only confirms the central role of CRF in alcohol addiction using a variety of different methods, but also shows that in rats the hormone can be blocked on a long-term basis to alleviate the symptoms of alcohol dependence.

Previous research had implicated CRF in alcohol dependence, but had shown the effectiveness of blocking CRF only in acute single doses of an antagonist (a substance that interferes the physiological action of another). The current study used three different types of CRF antagonists, all of which showed an anti-alcohol effect via the CRF system. In addition, the chronic administration of the antagonist for 23 days blocked the increased drinking associated with alcohol dependence.

Out of Control

Alcoholism, a chronic disease characterized by compulsive use of alcohol and loss of control over alcohol intake, is devastating both to individuals and their families and to society in general. About a third of the approximately 40,000 traffic fatalities every year involve drunk drivers, and direct and indirect public health costs are estimated to be in the hundreds of billions of dollars yearly.

“Research to understand alcoholism is important for society,” said Roberto, a 2010 recipient of the prestigious Presidential Early Career Award for Scientists and Engineers. “Our study explored what we call in the field ‘the dark side’ of alcohol addiction. That’s the compulsion to drink, not because it is pleasurable—which has been the focus of much previous research—but because it relieves the anxiety generated by abstinence and the stressful effects of withdrawal.”

CRF is a natural substance involved in the body’s stress response. Originally found only in the area of the brain known as the hypothalamus, it has now been localized in other brain regions, including the pituitary, where it stimulates the secretion of corticotropin and other biologically active substances, and the amygdala, an area that has been implicated in the elevated anxiety, withdrawal, and excessive drinking associated with alcohol dependence.

To confirm the role of CRF in the central amygdala for alcohol dependence, the research team used a multidisciplinary approach that included electrophysiological methods not previously applied to this problem.

The results from these cellular studies showed that CRF increased the strength of inhibitory synapses (junctions between two nerve cells) in neurons in a manner similar to alcohol. This change occurred through the increased release of the neurotransmitter GABA, which plays an important role in regulating neuronal excitability.

Blocking the Stress Response

Next, the team explored if the effects of CRF could be blocked through the administration of CRF antagonists. To do this, the scientists tested three different CRF1 antagonists (called antalarmin, NIH-3, and R121919) against alcohol in brain slices and injected R121919 for 23-days into the brains of rats that were exposed to conditions that would normally produce a dependence on alcohol.

Remarkably, the behavior of the “alcohol-dependent” rats receiving one of the CRF antagonists (R121919) mimicked their non-addicted (”naïve”) counterparts. Instead of seeking out large amounts of alcohol like untreated alcohol-dependent rats, both the treated rats and their non-addicted brethren self-administered alcohol in only moderate amounts.

“This critical observation suggests that increased activation of CRF systems mediates the excessive drinking associated with development of dependence,” said Roberto. “In other words, blocking CRF with prolonged CRF1 antagonist administration may prevent excessive alcohol consumption under a variety of behavioral and physiological conditions.”

Importantly, in the study the rats did not exhibit tolerance to the suppressive effects of R121919 on alcohol drinking. In fact, they may have become even more sensitive to its effects over time—a good sign for the efficacy of this type of compound as it might be used repeatedly in a clinical setting.

The scientists’ cellular studies also supported the promising effects of CRF1 antagonists. All of the CRF antagonists decreased basal GABAergic responses and abolished alcohol effects. Alcohol-dependent rats exhibited heightened sensitivity to CRF and the CRF1 antagonists on GABA release in the central amygdala region of the brain. CRF1 antagonist administration into the central amygdala reversed dependence–related elevations in extracellular GABA and blocked alcohol-induced increases in extracellular GABA in both dependent and naive rats. The levels of CRF and CRF1 mRNA in the central amygdala of dependent rats were also elevated.

Roberto notes that another intriguing aspect of the work is that it provides a possible physiological link between stress-related behaviors, emotional disorders (i.e. stress disorders, anxiety, depression), and the development of alcohol dependence.

One of many reasons that attendance at Alcoholics Anonymous (AA) meetings helps people with alcohol use disorders stay sober appears to be alleviation of depression. A team of researchers has found that study participants who attended AA meetings more frequently had fewer symptoms of depression – along with less drinking – than did those with less AA participation. The report will appear in the journal Addiction and has been release online.

“Our study is one of the first to examine the mechanisms underlying behavioral change with AA and to find that AA attendance alleviates depression symptoms,” says study leader John F. Kelly, PhD, associate director of the Massachusetts General Hospital (MGH) Center for Addiction Medicine. “Perhaps the social aspects of AA helps people feel better psychologically and emotionally as well as stop drinking.”

The authors note that problems with mood regulation such as depression are common among people with alcohol problems – both preceding and being exacerbated by alcohol use. Although AA does not explicitly address depression, the program’s 12 steps and social fellowship are designed to support participants’ sense of well being. While mood problems often improve after several weeks of abstinence, that process may happen more quickly in AA participants. The current study was designed to investigate whether decreasing depression and enhancing psychological well-being help explain AA’s positive effects.

A.A. Can Relieve Depression Symptoms

The researchers analyzed data from Project MATCH, a federally funded trial comparing three treatment approaches for alcohol use disorder in more than 1,700 participants. While participants in that study were randomly assigned to a specific treatment plan, all were able to attend AA meetings as well. Among the data gathered at several points during Project MATCH’s 15-month study period were participants’ alcohol consumption, the number of AA meetings attended, and recent symptoms of depression.

At the beginning of the study period, participants reported greater symptoms of depression than would be seen in the general public, which is typical among alcohol-dependent individuals. As the study proceeded, those participants who attended more AA meetings had significantly greater reductions in their depression symptoms, along with less frequent and less intensive drinking.

“Some critics of AA have claimed that the organization’s emphasis on ‘powerlessness’ against alcohol use and the need to work on ‘character defects’ cultivates a pessimistic world view, but this suggests the opposite is true,” Kelly says. “AA is a complex social organization with many mechanisms of action that probably differ for different people and change over time. Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood. Who wouldn’t want that?”

Parents who try to teach responsible drinking by letting their teenagers have alcohol at home may be well intentioned, but they may also be wrong, according to a new study in the latest issue of the Journal of Studies on Alcohol and Drugs.

Risks of Developing Alcohol Problems

In a study of 428 Dutch families, researchers found that the more teenagers were allowed to drink at home, the more they drank outside of home as well. What’s more, teens who drank under their parents’ watch or on their own had an elevated risk of developing alcohol-related problems.

Drinking problems included trouble with school work, missed school days and getting into fights with other people, among other issues.

The findings, say the researchers, put into question the advice of some experts who recommend that parents drink with their teenage children to teach them how to drink responsibly — with the aim of limiting their drinking outside of the home.

That advice is common in the Netherlands, where the study was conducted, but it is based more on experts’ reasoning than on scientific evidence, according to Dr. Haske van der Vorst, the lead researcher on the study.

“The idea is generally based on common sense,” says van der Vorst, of Radboud University Nijmegen in the Netherlands. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.”

But the current findings suggest that is not the case.

Don’t Let Children Drink

Based on this and earlier studies, van der Vorst says, “I would advise parents to prohibit their child from drinking, in any setting or on any occasion.”

The study included 428 families with two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.

The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home. In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.

Drinking Begets More Drinking

The findings, according to van der Vorst, suggest that teen drinking begets more drinking — and, in some cases, alcohol problems — regardless of where and with whom they drink.

“If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence,” she says, “they should try to postpone the age at which their child starts drinking.”

An analysis of published studies on the relationship between Alzheimer’s disease and smoking indicates that smoking cigarettes is a significant risk factor for the disease. After controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors, the UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of AD, while independent studies showed that smoking increased the risk of developing the disease.

Study findings were published online in the Journal of Alzheimer’s Disease. An abstract of the paper is available at the link below.

Smoking Not Protective

“For many years, published studies and popular media have perpetuated the myth that smoking is protective against the development of AD. The disease’s impact on quality of life and health care costs continues to rise. It is therefore critical that we better understand its causes, in particular, the role of cigarette smoking,” said Janine K. Cataldo, PhD, RN, assistant professor in the UCSF School of Nursing and lead author of the study.

According to the Alzheimer’s Association, 5.3 million Americans currently have the disease, and that number will escalate rapidly as the baby boom generation ages. AD also triples health care costs for Americans aged 65 and older, the organization states.

The UCSF team reviewed 43 published studies from 1984 to 2007. Authors of one-fourth of the studies had an affiliation with the tobacco industry.

The UCSF team determined that the average risk of a smoker developing AD, based on studies without tobacco industry affiliation, was estimated to be 1.72, meaning that smoking nearly doubled the risk of AD. In contrast, the team found that studies authored by individuals with tobacco industry affiliations, showed a risk factor of .86 (less than one), suggesting that smoking protects against AD. When all studies were considered together, the risk factor for developing AD from smoking was essentially neutral at a statistically insignificant 1.05.

Previous reviews of the association between smoking and AD have not controlled for study design and author affiliation with the tobacco industry, according to Cataldo. To determine if study authors had connections to the tobacco industry, the UCSF team analyzed 877 previously secret tobacco industry documents.

Corrosive Tobacco Research

The researchers used an inclusive definition of “tobacco industry affiliation” and examined authors’ current or past funding, employment, paid consultation, and collaboration or co-authorship on a study with someone who had current or previous tobacco industry funding within 10 years of publication.

“We know that industry-sponsored research is more likely to reach conclusions favorable to the sponsor,” said Stanton A. Glantz, PhD, of the UCSF Department of Medicine and a study co-author. “Our findings point to the ongoing corrosive nature of tobacco industry funding and point to the need for academic institutions to decline tobacco industry funding to protect the research process.”

Judith J. Prochaska, PhD, MPH, of the UCSF Department of Psychiatry, also is a co-author.  The team’s research was supported by grants from the California Tobacco Related Disease Research Program, the National Cancer Institute, and the National Institute on Drug Abuse.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Reducing obesity and smoking have become national priorities in the United States. Research has shown that intensive counseling can positively impact each problem. However, because such counseling is typically not covered by medical insurance, cost can be a barrier. In a study published in the March 2010 issue of the American Journal of Preventive Medicine, researchers from Virginia Commonwealth University, Richmond, Virginia, found that when primary care clinicians and community counselors collaborated to offer free counseling services to patients, there was an overwhelming positive response. Yet, when the same services were offered at a cost to the patient, there was a significant drop in participation.

Unhealthy Behavior

An electronic linkage system (eLinkS) was used to prompt healthcare providers to suggest intensive healthcare counseling for adult patients with unhealthy behaviors. eLinkS then helped to facilitate and automate referrals and communication between primary care practices and community programs. During a 5-week period when funding was available, 5679 patients were evaluated, 1860 had at least one unhealthy behavior (triggering an eLinkS prompt), and 407 (21.8%) were referred for intensive counseling.

In a 3-week period after funding was exhausted, 2510 patients visited the practices, 729 triggered an eLinkS prompt, but only 5 (0.7%) were referred for intensive counseling. Compared to the coverage period, the overall referral rate for patients with an unhealthy behavior decreased by 97%. Practice nurses asked 22% fewer patients about health behaviors (37% vs 29%). When prompted by eLinkS, clinicians offered referrals to 79% fewer patients (29% vs 6%). If a referral was offered, 81% fewer patients accepted (76% vs 14%).

Cost Was a Problem

Patients confirmed that costs introduced a barrier to counseling. Some patients were explicit that charges would prevent participation while others who had deferred counseling in the past were motivated to enroll because it was free. Clinicians reported that removing cost as an impediment, combined with an easy means to refer patients, allowed patient discussions to focus on behavior change. The heightened patient interest reversed when charges were reinstituted. Fewer successes also diminished motivation for the counselors.

Alex H. Krist MD, MPH, Virginia Commonwealth University, Department of Family Medicine, and his co-investigators comment, “Our quantitative and qualitative data underscore that clinicians, not just patients, are influenced by costs. Despite prompts, nurses were less likely to record patients’ BMI and smoking status during the no-coverage period, triggering fewer eLinkS prompts. Clinicians were also less likely to discuss health behaviors with patients. However, even when clinicians did offer a referral, 81% fewer patients accepted. …This study indicates that policymakers and payers should support clinical–community partnerships and eliminate cost as a barrier to intensive smoking cessation and weight loss counseling. Modifying health behaviors is daunting enough for patients and clinicians – cost can be the tipping point in their decision to forego the effort.”