Substance Abuse News

The U.S. Joint Commission recently approved new hospital accreditation measures related to alcohol screening, brief intervention, and referral to treatment (SBIRT) for all hospitalized patients. Yet little is known about the effectiveness of brief interventions (BIs) or inpatient acceptability of SBIRT when performed by healthcare professionals other than physicians. A new study has found high hospital-patient acceptability of and comfort with nurse-delivered SBIRT.

Results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research.

Identifying Unhealthy Alcohol Use

“SBIRT is widely endorsed for identifying and managing unhealthy alcohol use that ranges from hazardous or ‘risky’ drinking to the more serious alcohol abuse and dependence,” explained Lauren M. Broyles, a research health scientist at the VA Pittsburgh Healthcare System, assistant professor of medicine at the University of Pittsburgh, and corresponding author for the study.

“A more recent focus has extended to identification of hazardous drinking – consumption that exceeds guidelines established by the National Institute on Alcohol Abuse and Alcoholism – as more than 14 standard drinks/week or more than four/occasion for men, and more than seven standard drinks/week or more than three/occasion for women and healthy individuals age 65 or older,” she said. “Despite [supporting] evidence, recommendations and mandates concerning SBIRT implementation, uptake by healthcare providers in real-world clinical settings is still relatively limited.”

“SBIRT is a brief conversation, about 10 to 15 minutes, about hazardous alcohol consumption,” added Deborah S. Finnell, a research nurse scientist at the VA Western New York Healthcare System and associate professor of nursing at the University at Buffalo. “Healthcare team members could easily deliver SBIRT, assuming they are qualified. Since nurses provide 24-hour care in hospitals, nurses are most likely to have contact with patients compared with other healthcare team members, such as physicians and social workers.”

High Rate of Acceptability

Broyles and her colleagues conducted a cross-sectional survey of 355 (342 males, 13 females) hospitalized medical-surgical patients at a large university-affiliated medical center that is part of the U.S. Department of Veterans Affairs.

Results indicated acceptability for nurse-delivered SBIRT was high. Patient acceptability for eight out of 10 individual nurse-delivered SBIRT tasks was greater than 84 percent. Roughly 20 percent of the patients reported some degree of personal discomfort with the discussions; in general these individuals had a lower belief in their ability to reduce their drinking risk, were older than 60 years of age, had a positive alcohol screening, and were of non-black race.

“We found, in general, that acceptability for nurse-delivered SBIRT tasks was associated with how people perceived their own alcohol-related risks,” explained Broyles. “Patients had higher acceptability if they felt that they were able to determine and reduce their own alcohol-related health risks, and if they had expressed concern about their own alcohol use. Conversely, roughly 20 percent of the patients expressed annoyance or embarrassment with the questions while also showing high levels of acceptability. While this might seem contradictory, patients might feel embarrassed or uncomfortable with the topic or discussion even though they see the discussions as a legitimate, necessary, and acceptable part of the nurse’s role.”

Alcohol and Health Risks

“This study also highlights the importance of being patient-centered,” said Finnell. “Patients are accepting of receiving information from nurses about changing their alcohol use and about self-help groups. Specifically, when patients can make the connection between their alcohol use and health risks, they may be more accepting of having the conversation with the nurse and continuing that conversation about decreasing the amount of alcohol they consume. Additionally, nurses providing patient-centered care will be sensitive to signs that the patient is uncomfortable during the conversation.”

Broyles agreed. “For hazardous drinkers, nurses and other healthcare providers can normalize alcohol screening and BI by drawing analogies, for themselves and their patients, to screening and structured health behavior advice for other health conditions,” she said. “Normalizing talk about unhealthy alcohol use and alcohol use disorders in general medical settings, by general medical providers, in general medical encounters in this way may help both providers and patients feel more comfortable.”

Finnell said she was not surprised that patients were comfortable with nurse-delivered SBIRT. “I have been amazed at what patients share with me during my interactions with them,” she said. “Americans consistently rank nurses ‘very high’ or ‘high’ on honesty and ethical standards. The concept of trust is an important element in the nurse-patient relationship.”

Appropriate Training Needed

Both Broyles and Finnell emphasized the need for appropriate training, practice, support, and pragmatic strategies for incorporating alcohol SBIRT into existing clinical practices and routines. “Our findings suggest that once trained in SBIRT and motivational interviewing techniques, providers can proceed with greater confidence in alcohol-related risk assessment and risk-reduction conversations with patients,” said Broyles.

“While this study focused on nurse-delivered SBIRT, the take-home points are highly relevant to other clinicians,” added Finnell. “Clinicians who have been asked about barriers to delivering SBIRT report concern about jeopardizing their relationship with the patient. This study shows that patients are accepting of alcohol-related discussions, particularly brief counseling about alcohol, educational materials about changing alcohol use, and information about alcohol self-help groups. The findings from this study should alert nurses, physicians, and other health care providers to be prepared to meet the needs of these patients.”

Quitting smoking is never easy. However, when you’re poor and uneducated, kicking the habit for good is doubly hard, according to a new study by a tobacco dependence researcher at The City College of New York (CCNY).

Christine Sheffer, associate medical professor at CCNY’s Sophie Davis School of Biomedical Education, tracked smokers from different socioeconomic backgrounds after they had completed a statewide smoking cessation program in Arkansas.

Whether rich or poor, participants managed to quit at about the same rate upon completing a program of cognitive behavioral therapy, either with or without nicotine patches. But as time went on, a disparity between the groups appeared and widened.

Hardest Time With Cravings

Those with the fewest social and financial resources had the hardest time staving off cravings over the long run. “The poorer they are, the worse it gets,” said Professor Sheffer, who directed the program and was an assistant professor with the University of Arkansas for Medical Sciences at the time.

She found that smokers on the lowest rungs of the socioeconomic ladder were 55 percent more likely than those at the upper end to start smoking again three months after treatment. By six months post-quitting, the probability of their going back to cigarettes jumped to two-and-a-half times that of the more affluent smokers. The research will be published in the March 2012 issue of the “American Journal of Public Health” and will appear ahead-of-print online under the journal’s “First Look” section.

More Poor People Smoke

In their study, Professor Sheffer and her colleagues noted that overall, Americans with household incomes of $15,000 or less smoke at nearly three times the rate of those with incomes of $50,000 or greater. The consequences are bleak. “Smoking is still the greatest cause of preventable death and disease in the United States today,” noted Professor Sheffer. “And it’s a growing problem in developing countries.”

Professor Sheffer suggested reasons it may be harder for some to give up tobacco forever.

Smoking relieves stress for those fighting nicotine addiction, so it is life’s difficulties that often make them reach for the cigarette pack again. Unfortunately, those on the lower end of the socioeconomic scale suffer more hardships than those at the top – in the form of financial difficulties, discrimination, and job insecurity, to name a few. And for those smokers who started as teenagers, they may have never learned other ways to manage stress, said Professor Sheffer.

For people with lower socioeconomic status (SES), it can be tougher to avoid temptation as well. “Lower SES groups, with lower paying jobs, aren’t as protected by smoke-free laws,” said Sheffer, so individuals who have quit can find themselves back at work and surrounded by smokers. Also fewer of them have no-smoking policies in their homes.

Not Addressed in Treatment

These factors are rarely addressed in standard treatment programs. “The evidence-based treatments that are around have been developed for middle-class patients,” Professor Sheffer pointed out. “So (in therapy) we talk about middle-class problems.”

Further research would help determine how the standard six sessions of therapy might be altered or augmented to help. “Our next plan is to take the results of this and other studies and apply what we learned to revise the approach, in order to better meet the needs of poor folks,” she said. “Maybe there is a better arrangement, like giving ‘booster sessions’. Not everybody can predict in six weeks all the stresses they will have later on down the road.”

“Some people say [quitting] is the most difficult thing in their life to do,” said Sheffer. “If we better prepare people with more limited resources to manage the types of stress they have in their lives, we’d get better results. “

The research was funded by National Institutes of Health National Cancer Institute (R03 CA141995–01A1) and the National Center for Research Resources (RR 020146). The treatment program was funded by the Arkansas Department of Health.

Individuals addicted to prescription painkillers are more likely to succeed in treatment with the aid of the medication buprenorphine-naloxone (Suboxone), report McLean Hospital and Harvard Medical School researchers in today’s online edition of the Archives of General Psychiatry.

“Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence,” is the first large-scale study to address treatment of prescription opioid addiction.

Addicted to Painkillers

According to lead author Roger Weiss, MD, Chief of the Division of Alcohol and Drug Abuse at McLean Hospital, most studies examining treatments for opioid dependence have been done with heroin-dependent patients at methadone clinics, resulting in the lack of data on treatment for patients addicted to prescription painkillers, especially in the offices of primary care doctors.

“Despite the tremendous increase in the prevalence of addiction to prescription painkillers, little research has focused on this patient population,” said Weiss, a professor of Psychiatry at Harvard Medical School. “This is notable because recent data tell us that the use of prescription painkillers for non-medical reasons is 20 times more common than heroin and 50 percent more people seek treatment for prescription drug abuse than for heroin.”

600 Patients Studied

Part of the National Institute on Drug Abuse (NIDA) Clinical Trials Network, this is the first randomized large scale clinical trial for the treatment of prescription opioid abuse, involving 10 sites nationwide and more than 600 treatment-seeking outpatients dependent on prescription opioids and either taking more than prescribed or using them illicitly. Each participant received Suboxone—a combination of buprenorphine, which alleviates opioid withdrawal and craving, and naloxone, which prevents abuse if the drug is not taken orally as prescribed—in conjunction with Standard Medical Management, in which physicians evaluated treatment effectiveness and recommended abstinence and self-help participation. Fifty percent of study participants also received additional more intensive individual addiction counseling.

According to Weiss, 49 percent of patients benefitted from Suboxone during a 12-week course of the medication. However, once the medication was discontinued, patients had a high rate of relapse. Monitored in four week increments, individuals showed an increasing rate of relapse the longer they remained off Suboxone. Another interesting finding, noted Weiss was that neither having chronic pain, nor participation in intensive addiction counseling affected the participant’s success rate.

Suboxone and Recovery

“We were surprised by some of these findings because there was an overall assumption that this population—those who have had little to no exposure to heroin—would do better in terms of not needing long-term medication intervention,” said Weiss. “It is clear that given the prescription drug abuse epidemic, we need to continue to look at the viability of longer-term use of Suboxone and whether it can continue to provide sustained recovery from addiction to pain medications.”

According to the National Survey on Drug Use and Health, an estimated 1.9 million people in the United States meet abuse or dependence criteria for prescription pain relievers. In addition, the Centers for Disease Control and Prevention report that annually, more people die from prescription painkiller overdoses than from heroin and cocaine combined.

Researchers know that alcohol impairs coordination and the ability to perceive and respond to hazards, and that hangovers impair neurocognitive performance and psychomotor vigilance. This study closely examined alcohol-related injuries admitted to hospital, finding that alcohol greatly increases risk for serious injury.

Results will be published in the January 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“We know that alcohol is more heavily involved in fatalities than injuries,” said Ted R. Miller, a senior research scientist at the Pacific Institute for Research and Evaluation and corresponding author for the study. “It is less clear whether and how heavily alcohol is involved in serious injury.”

Alcohol and Injuries

“It is important to understand the proportion of injury attributable to alcohol for those injuries which are more severe and subsequently hospitalized, compared to those not needing hospitalization,” said Cheryl J. Cherpitel, a senior scientist with the Alcohol Research Group. “Taken together, both are important for a more comprehensive understanding of the proportional decline in injury in the absence of alcohol.”

The study authors combined national alcohol consumption data with alcohol metabolism rates to estimate hours that heavy drinkers versus other drinkers and non-drinkers spent as “alcohol positive” versus “alcohol negative” within one calendar year.

“If we know how much alcohol people drink, we can estimate how many hours per day people are alcohol-positive versus alcohol-negative,” explained Miller. “Dividing the number of alcohol-positive injuries by the number of alcohol-positive hours indicates injury-risk when alcohol-positive. A similar calculation gives the alcohol-negative risk.”

Results showed that alcohol consumption is a major cause of hospitalized injury. Even though heavy drinkers generally lead risky lifestyles, and even though they tolerate alcohol better than most drinkers, their injury risks still tripled when they drank.

4.5 Times Higher Risk

“Risk during hours that people were alcohol-positive was 4.5 times their risk when sober,” said Miller. “Heavy drinkers claim they can handle their alcohol. Within limits, that’s true. Alcohol raises a heavy drinker’s injury risk less than an average person’s risk. Still, a heavy drinker is three times more likely to be injured during an alcohol-positive than a sober hour. Possibly due to hangover effects, heavy drinkers also are 1.35 times as likely as other people to be injured when sober. Alcohol especially raises risk for assault, near drowning, non-elderly fall, and pedestrian injuries. An estimated 36 percent of hospitalized assaults and 21 percent of all injuries are attributable to alcohol use by the injured person.”

“Non-heavy drinkers also seem to have a higher risk of injury-related hospitalization when alcohol positive compared to alcohol-positive heavy drinkers,” said Cherpitel, “likely due to their not being accustomed to alcohol’s effects, while heavier drinkers have developed a tolerance to alcohol and are therefore less affected by the same amount of alcohol. It is also possible that heavier drinkers may have consumed so much alcohol that they are unable to place themselves in risky situations that may result in injury; for example, they may become a passenger in a vehicle and sleep rather than attempt to drive. These findings are similar to those from our emergency-room studies.”

Warning Labels Needed

“Our estimates set the stage for injury-warning labels on alcohol bottles,” said Miller. “They also suggest what percentage of public injury cost justifiably could be recovered through alcohol taxes. Moderate drinking has not traditionally been considered hazardous. Yet from an injury viewpoint, it appears to be more hazardous per drink than regular heavy drinking. Moderate drinkers who occasionally drink to excess suffer more injuries than heavy drinkers per alcohol-positive hour. Nonetheless, intervention rarely has been targeted to this group because its high risk was hidden.”

“Certainly these findings point to the importance of screening and brief intervention in clinical practice,” added Cherpitel, “as well as advancing public health knowledge regarding the potential effects of even small quantities of alcohol. Injury research needs to consider that even a small amount of alcohol in less experienced drinkers can be especially dangerous when undertaking potentially risky activities such as driving or using heavy equipment.”

For the first time, new research shows that patterns of alcohol consumption – a drink or two every night, or several cocktails on Friday and Saturday nights only – may be more important in determining alcohol’s influence on heart health than the total amount consumed.

In the journal Atherosclerosis, scientists found that daily moderate drinking – the equivalent of two drinks per day, seven days a week – decreased atherosclerosis in mice, while binge drinking – the equivalent of seven drinks a day, two days a week – increased development of the disease. Atherosclerosis, or the hardening and narrowing of arteries, is a serious condition that can lead to a heart attack or stroke.

Binge Drinking and Vascular Disease

While population studies support an association between alcohol and cardiovascular disease, they’ve relied on self-reported data, which is not always accurate or reliable. According to study authors, this is the first study to provide concrete evidence linking drinking patterns to the development of vascular disease, and the nearly 15 percent of Americans who binge drink – as estimated by the Centers for Disease Control and Prevention – should take note.

“People need to consider not only how much alcohol they drink, but the way in which they are drinking it,” said lead study author John Cullen, Ph.D., research associate professor in the Department of Surgery at the University of Rochester Medical Center. “Research shows that people have yet to be convinced of the dangers of binge drinking to their health; we’re hoping our work changes that.”

Scientists don’t yet understand how moderate alcohol consumption benefits cardiovascular health or how heavy drinking episodes hurt it.

A Standard Drink

The National Institute on Alcohol Abuse and Alcoholism defines binge or “at-risk” drinking as consuming more than four drinks on any day for men, and more than three drinks on any day for women. Understanding how much alcohol is in a “standard” drink is also critical, something the institute is promoting through its new “Rethinking Drinking” campaign.

Health care professionals also need to be aware that drinking style matters and should address the issue when discussing alcohol consumption with patients, especially those who are at higher risk of atherosclerosis or who have suffered a heart attack in the past, added Cullen.

“This evidence is very interesting because it supports a pattern of drinking that is emerging in clinical studies as both safe and seemingly most protective against heart disease – frequent consumption of limited amounts of alcohol. This certainly backs up widespread clinical guidelines that limit drinking to one drink daily for non-pregnant women and two drinks daily for men,” said Kenneth Mukamal, M.D., M.P.H., Associate Professor of Medicine at Harvard Medical School who studies the role of dietary and lifestyle factors, particularly alcohol consumption, on the incidence of cardiovascular and neurovascular disease.

Mice on High-Fat Diet

In the study, mice in the “daily-moderate” group were fed ethanol equivalent to two drinks every day of the week, mice in the “weekend-binge” group were fed approximately seven drinks on two days of the week and mice in the control group were fed a non-alcoholic cornstarch mix. All mice were put on an atherogenic diet, which Cullen equates to a high-fat Western diet – think fried food every day – to encourage the development of atherosclerosis, which forms when fatty deposits or plaque collect on the inner walls of the arteries, causing them to narrow.

Levels of LDL or “bad” cholesterol plummeted 40 percent in the daily-moderate drinking mice, but rose 20 percent in the weekend-binge drinking mice, compared to the no-alcohol controls. High levels of bad cholesterol increase the risk of heart disease, and past studies show that every 10 percent increase in LDL results in a 20 percent increase in atherosclerosis risk.

Surprisingly, levels of HDL or “good” cholesterol went up in both the moderate and binge drinking groups, which Cullen speculates is an acute or short-term effect.

Narrowing of the Arteries

The volume of plaque, as well as the accumulation of immune cells that promote inflammation and consequently contribute to the narrowing of arteries, decreased in the moderate mice compared to no-alcohol mice. The opposite occured in the binge-drinking mice: Plaque volume and the number of inflammatory immune cells grew.

Another unexpected yet noteworthy finding was that the binge drinking mice gained significantly more weight than the moderate and control mice. Though all mice started at approximately the same weight and consumed similar amounts of food over the course of the study, the binge mice gained more than three times as much weight as the moderate mice and about twice as much weight as the control mice.

Building on this study, Cullen is investigating genes that are turned on or off following moderate and binge drinking episodes to determine if they influence outcomes.

Binge Drinker Have Increased Risk

The research was supported in part by the Founders Affiliate of the American Heart Association, which supports research exploring new ideas to combat cardiovascular disease. Founders Affiliate research committee chair Lucy Liaw, Ph.D. said these first-time findings could have far-reaching public health implications. “The discoveries of Dr. Cullen’s group show that binge drinkers may have increased risk of developing atherosclerosis and experiencing weight gain. Because obesity is also a risk factor for disease, binge drinking may have a strong negative impact on cardiovascular health,” said Liaw, who is also a member of the AHA national research committee.

The study was also funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. In addition to Cullen, Weimin Liu, M.D., Ph.D., Eileen Redmond, Ph.D. and David Morrow, Ph.D. from the Medical Center contributed to the research.

A study by the University of Liverpool has found that a decrease in smoking rapidly reduces mortality rates in individuals and entire populations within six months.

Research by Professor Simon Capewell and Dr Martin O’Flaherty at the Institute of Psychology, Health and Well-being, examined evidence from clinical trials and natural experiments. They found that a reduction in smoking has a positive impact on mortality rates in both individuals and populations within six months. Likewise, dietary improvements get very positive results within one to three years.

Benefits Happen Quickly

Professor Capewell said:”Our research found that smoking bans and diet improvements powerfully and rapidly reduce chronic disease in both individuals and in the wider population. This actually happens quickly, within a far shorter timescale than had previously been assumed; within months and years rather than decades. This discovery means that policies such as smoking bans or reducing saturated fats are effective at improving health and would save the NHS millions very rapidly.”

The study found that policies that reduce smoking consistently have a rapidly positive effect on mortality rates and hospital admissions in countries and communities around the world. After smoke-free legislation was introduced in Scotland in 2006, hospital admissions for acute coronary syndrome decreased by 17% with a 6% decrease in out-of-hospital cardiac deaths.

Similarly, when smoke-free legislation was introduced in Helena, an isolated community in the US, it resulted in a 40% drop in admission rates for acute coronary syndrome within six months in one hospital. When the law was repealed the coronary admissions returned to previous levels within six months.

Diet Changes Help Too

Changes to diet also have a rapid and positive impact on the reduction of mortality rates for coronary heart disease. Coronary death rates rose steadily during the 20th Century, peaking in the 1970s in the UK, US and Western Europe. However, closer scrutiny of national trends revealed a notch in the early 1940s. This has been attributed to sudden decreases in dietary meat and animal fats due to food rationing during the Second World War.

More recently, a study of coronary disease in Poland found that death rates from heart disease had been rising steadily. From 1990, however, they quickly dropped by 25% after meat and animal fat subsidies from the communist countries ceased and cheap vegetable oils and fruit flooded the market. A study of other central European countries confirmed very similar trends.

Excessive drinking and an unbalanced diet are two preventable contributors to health problems in the developed world. Different studies have found varying linkages between amounts of alcohol consumed and quality of diet. A new study of adults in Spain has found that heavy drinking, binge drinking, a preference for spirits, and drinking alcohol at mealtimes were associated with a poor adherence to major food consumption guidelines.

Results will be published in the November 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Drinking alcohol may reduce maintaining a healthy diet, leading to adverse metabolic effects which in turn add to those directly produced by alcohol,” said José Lorenzo Valencia-Martín, a doctor at the Universidad Autónoma de Madrid and corresponding author for the study. “The specific influence of alcohol on diet may depend upon the overall quantity of alcohol ingested, frequency of consumption, beverage preference, and whether alcohol intake takes place during the meals. Alcohol may indirectly contribute to several chronic diseases such as obesity, diabetes mellitus, cardiovascular disease, or cancer.”

Careless Dietary Habits

“Unhealthy lifestyles tend to cluster together, but this is not a ‘necessary’ association,” added Miguel A. Martínez-González, chair of the department of preventive medicine and Public Health at the University of Navarra. “On average, people who drink excessive alcohol are more likely to be careless in their dietary habits. A high alcohol intake is especially unhealthy with respect to liver disease. A high-energy food pattern rich in trans fats – such as ‘fast-foods’ or items from a commercial bakery – is also likely to be related to liver disease. In this sense, if both unhealthy lifestyles cluster together, they can act synergistically to produce very adverse effects.”

“In Spain, alcohol is frequently drunk during meals, particularly lunch and dinner,” said Valencia-Martín. “Because of this, and the lower prevalence of abstainers, our findings apply to most adults in Spain and in other Mediterranean countries in Europe. Our results are of relevance because they show that drinking at mealtimes is associated with insufficient intake of healthy foods, such as fruits and vegetables, and with excessive intake of animal protein.”

Unintended Consequences

From 2000 to 2005, the researchers carried out a telephone survey of 12,037 adults (5850 men, 6187 women) considered representative of 18-to-64-year-olds in the region of Madrid. Binge drinking was defined as equal to or more than 80 grams of alcohol for men and equal to or more than 60 grams for women during one drinking session; the threshold between moderate and heavy drinking was 40 grams of alcohol per day for men and 24 grams per day for women. Food consumption was measured using a 24-hour recall.

“Excessive drinkers, either with or without binge drinking, showed a poor adherence to dietary recommendations,” said Valencia-Martín. “Although drinking at mealtimes has traditionally been considered a safe or even a healthy behavior, our results point to some unintended consequences that the general populations should be aware of. In particular, drinking at mealtimes is associated with poor adherence to most of the food consumption guidelines. Also, not all types of alcoholic beverages are equal with regard to their dietary effects; our results suggest that a preference for spirits is associated with a poorer diet. Lastly, the above implications apply to both men and women.”

“I believe the key finding of this study is the suggestion of a harmful effect of binge drinking on healthy eating habits,” said Martínez González. “Binge drinking prevalence was found to be relatively high – greater than 10 percent – in a representative sample of Spanish population. This is very bad news. Alcohol misuse has become a priority public-health problem in Spain, especially because of rising rates of binge drinking and especially because of the abandonment of the traditional Mediterranean pattern of moderate alcohol drinking, in little amounts, generally red wine during meals. Recent changes, especially among young Spanish people, include a pattern of high amounts of spirits during weekends. This excellent study adds another unfortunate consequence of this change: the impairment of eating habits.”

Alcohol Replaces Healthy Calories

Martínez González added that both alcohol researchers and clinicians need to pay more attention to the dietary pattern of binge drinkers, and also consider that some of the detrimental effects attributed to alcohol might in fact be consequences of a poor diet.

“Don’t forget that alcohol is addictive, that it replaces healthy calories from other foods by empty calories, meaning these calories are devoid of minerals and vitamins,” said Martínez González. “Keep also in mind that the drinking pattern might be more important than the total amount consumed. The unhealthiest pattern is to consume high amounts – three to four drinks per day – of spirits or beer exclusively during the weekends. Conversely, the healthiest use of alcohol may be red wine, no more than one glass per day for women and two per day for men, and consumed during meals in a regular daily pattern.”

Large amounts of alcohol are known to shorten sleep latency, increase slow-wave sleep, and suppress rapid eye movement (REM) during the first half of sleep. During the second half of sleep, REM increases and sleep becomes shallower. A study of the acute effects of alcohol on the relationship between sleep and heart rate variability (HRV) during sleep has found that alcohol interferes with the restorative functions of sleep.

Results will be published in the November 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Alcohol affects overall sleep architecture,” said Yohei Sagawa, a medical doctor in the department of neuropsychiatry at the Akita University School of Medicine. “Normally, during physiologic nocturnal sleep in humans, the parasympathetic nervous system, responsible for ‘rest-and-digest’ activities, is dominant over the sympathetic nervous system, responsible for stimulating activities. We wanted to investigate how alcohol may change this complementary relationship.”

Unique Sleep-Alcohol Study

“I believe that the approach used in this study is unique,” added Seiji Nishino, director of the Sleep & Circadian Neurobiology Laboratory at Stanford University School of Medicine. “Although there are several studies monitoring HRV during sleep, as far as I know there is no report describing the effects of alcohol on autonomic nervous system during sleep using this parameter.”

Sagawa and his colleagues gave 10 healthy, male university students with a mean age of 21.6 years three different alcohol beverages at three week intervals: 0g (control), 0.5g (low dose), or 1.0g (high dose) of pure ethanol/kg of body weight. On the day of the experiment, a Holter electrocardiogram was attached to the subject for a 24-hour period; the subject was instructed to drink one of the three alcoholic beverages 100 minutes before going to bed; and polysomnography was then performed for eight hours. Power spectral analysis of the HRV was performed using the maximum entropy method, and the low- and high-frequency components along with their ratios were calculated.

“Our study showed that alcohol suppresses the high-frequency power during sleep in a dosage-dependent manner,” said Sagawa. “Although the first half of sleep after alcohol intake looks good on the EEG, the result of the assessment regarding the autonomic nerve system shows that drinking leads to insomnia rather than good sleep.”

Heart Rate Increase

More specifically, as alcohol consumption increased, the heart rate increased and the spectral power of HRV measured at each frequency range decreased. Also, the low-frequency/high-frequency ratio that is considered an index of the balance between the sympathetic and parasympathetic systems was increased. This suggests that alcohol, in a dosage-dependent manner, suppresses the high-frequency component of HRV that is an indicator of parasympathetic nerve activity during sleep.

“The current study evaluates the acute effects after only a single dose of alcohol intake, and subsequently found a negative health consequence,” observed Nishino. “Many subjects habitually drink alcohol, and if the reduction of parasympathetic nerve activity during sleep chronically occurred, negative health consequences may be much larger and may induce various diseases. It is reported that habitual drinkers with hypertension are often associated with reductions of parasympathetic nerve activities.”

Many Alcoholics Have Insomnia

Sagawa agreed. “Many alcoholics and habitual drinkers suffer from insomnia,” he said. “Suppressed parasympathetic nerve activity is the result of alcohol drinking. Thus, it is inferred that suppressed parasympathetic nerve activity is associated with insomnia, which includes difficulty getting to sleep, early-morning awakening, lack of a sense of deep sleep, and difficulty maintaining sleep.”

“It is generally believed that having a nightcap may aid sleep, especially sleep initiation,” said Nishino. “This may be true for some people who have small amounts of alcohol intake. However, it should be noted that large amounts of alcohol intake interfere with sleep quality and the restorative role of sleep and these negative consequences may be much larger during chronic alcohol intake.”

Sagawa added that it is important for clinicians who are treating physical and psychological disorders related to alcohol to consider the disturbing effects on sleep’s restorative effects that habitual drinking can have.

Current cigarette smokers have a higher risk of bladder cancer than previously reported, and the risk in women is now comparable to that in men, according to a study by scientists from the National Cancer Institute (NCI), part of the National Institutes of Health. The report was published on Aug. 16, 2011, in the Journal of the American Medical Association.

This latest study uses data from over 450,000 participants in the NIH-AARP Diet and Health Study, a questionnaire-based study that was initiated in 1995, with follow-up through the end of 2006.

Female Bladder Cancer Link

While previous studies showed that only 20 to 30 percent of bladder cancer cases in women were caused by smoking, these new data indicate that smoking is responsible for about half of female bladder cancer cases – similar to the proportion found in men in current and previous studies. The increase in the proportion of smoking-attributable bladder cancer cases among women may be a result of the increased prevalence of smoking by women, so that men and women are about equally likely to smoke, as observed in the current study and in the U.S. population overall, according to surveillance by the CDC. The majority of the earlier studies were conducted at time periods or in geographic regions where smoking was much less common among women.

The researchers found that the amount of risk brought on by smoking, called excess risk, was higher in this study than in previously reported. “Current smokers in our study had a fourfold excess risk of developing bladder cancer, compared to a threefold excess risk in previous studies. The stronger association between smoking and bladder cancer is possibly due to changes in cigarette composition or smoking habits over the years,” said study author Neal Freedman, Ph.D., in NCI’s Division of Cancer Epidemiology and Genetics (DCEG). “Incidence rates of bladder cancer in the United States have been relatively stable over the past 30 years, despite the fact that smoking rates have decreased overall. The higher risk, as compared to studies reported in the mid-to-late 1990s, may explain why bladder cancer rates haven’t declined.”

Increase in Carcinogens

Although there have been reductions in the concentrations of tar and nicotine in cigarette smoke, there have been apparent increases in the concentrations of certain carcinogens associated with bladder cancer. A 2009 NCI/DCEG study was the first to suggest a higher risk for smoking-induced bladder cancer than previously reported. That report, based on data from the New England Bladder Cancer Study, found that the association between cigarette smoking and risk of bladder cancer appeared to be stronger than it was in the mid-1990s. The results of the new study confirm the 2009 report.

In the current study, former smokers were twice as likely to develop bladder cancer as never smokers, and current smokers were four times more likely than those who never smoked. As with many other smoking-related cancers, smoking cessation was associated with reduced bladder cancer risk. Participants who had been smoke-free for at least 10 years had a lower incidence of bladder cancer compared to those who quit for shorter periods of time or who still smoked.

20 Percent Still Smoke

“Our findings provide additional evidence of the importance of preventing smoking initiation and promoting cessation for both men and women,” said senior author Christian Abnet, Ph.D., also from DCEG. “Although the prevalence of cigarette smoking has declined, about 20 percent of the U.S. adult population continues to smoke.”

Even though smoking carries the same risk for men and women, men are still about four times more likely to be diagnosed with bladder cancer. These results, as well as those from previous studies, suggest that difference in smoking rates explain only part of the higher incidence rates in American men. The researchers suggest that occupational exposures, as well as physiologic differences, may contribute to the gender disparity.

In 2011, approximately 69,250 people will be diagnosed with bladder cancer in the United States, and 14,990 will die from the disease.

Two new studies have found that smokers who tend to take their first cigarette soon after they wake up in the morning may have a higher risk of developing lung and head and neck cancers than smokers who refrain from lighting up right away. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the results may help identify smokers who have an especially high risk of developing cancer and would benefit from targeted smoking interventions to reduce their risk.

Cigarette smoking increases one’s likelihood of developing various types of cancers. But why do only some smokers get cancer? Joshua Muscat, PhD, of the Penn State College of Medicine in Hershey, and his colleagues investigated whether nicotine dependence as characterized by the time to first cigarette after waking affects smokers’ risk of lung and head and neck cancers independent of cigarette smoking frequency and duration.

More Likely to Develop Cancer

The lung cancer analysis included 4,775 lung cancer cases and 2,835 controls, all of whom were regular cigarette smokers. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.31 times as likely to develop lung cancer, and those who smoked within 30 minutes were 1.79 times as likely to develop lung cancer.

The head and neck cancer analysis included 1,055 head and neck cancer cases and 795 controls, all with a history of cigarette smoking. Compared with individuals who smoked more than 60 minutes after waking, individuals who smoked 31 to 60 minutes after waking were 1.42 times as likely to develop head and neck cancer, and those who smoked within 30 minutes were 1.59 times as likely to develop head and neck cancer.

Higher Levels of Nicotine

These findings indicate that the need to smoke right after waking in the morning may increase smokers’ likelihood of getting cancer. “These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more,” said Dr. Muscat. “It may be a combination of genetic and personal factors that cause a higher dependence to nicotine.”

According to the authors, because smokers who light up first thing in the morning are a group that is at high risk of developing cancer, they would benefit from targeted smoking cessation programs. Such interventions could help reduce tobacco’s negative health effects as well as the costs associated with its use.