Archive for October, 2012

Alcohol dependence more deadly for women

While researchers and clinicians know that the mortality rates among alcohol dependent (AD) individuals are high, most of that knowledge is based on studies of clinical populations. A new study is the first to examine excess mortality and its predictors among AD individuals in the general population throughout a 14-year span, finding that annualized death rates were 4.6-fold higher for AD females and 1.9-fold higher for AD males when compared to the general population, indicating that females with AD merit particular attention.

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

Getting Treatment an Unknown Factor

“Clinical data have revealed a higher proportion of individuals who have died than among the general population of the same age,” explained Ulrich John, professor of epidemiology and social medicine, and director of the Institute of Epidemiology and Social Medicine at University Medicine Greifswald, Germany. “Gender-specific data are rare, even among clinical samples. Furthermore, these studies have two main limitations. First, we know that only a minority of AD individuals receive treatment of this disorder, but we lack knowledge about how this selection occurs. Second, we have no evidence about potential effects of specialized alcoholism treatment on mortality among people who had been diagnosed as AD. We would like to know whether treatment might enhance survival time. For ethical reasons, no controlled trials are possible. Thus, longitudinal descriptive data as in this study are helpful.”

John, the corresponding author for the study, added that Germany is well-suited for this kind of research since it is mandatory in that country for residents to provide vital status data. “Our data are also of international interest because researchers used the Composite International Diagnostic Interview (CIDI), which is an internationally and widely accepted instrument,” he said.

Cases Followed 14 Years

John and his colleagues used registration data to gather a random sample of 4,070 respondents between the ages of 18 and 64 years from a region in Germany; of these, 153 were identified as AD and, of these, 149 (119 males, 30 females) were successfully followed for 14 years. Baseline data included information garnered using the German version of the CIDI, AD diagnostic criteria from the Diagnostic and Statistical Manual of Mental Health Disorder – Fourth Edition (DSM-IV), and any other psychiatric disorders according to the DSM-IV. Possible predictors of mortality included AD treatment utilization, AD severity, alcohol-related problems, and self-rated health.

“First, we found that annualized death rates were 4.6-fold higher for females and 1.9-fold higher for males compared to the age- and gender-specific general population,” said John. “Second, we found that the mean age at death was 60 for females and 58 for males, both of which are about 20 years lower than the mean age at death among the general population. None of those deceased had reached the age of life expectancy. Third, having participated in inpatient AD treatment was not related with longer survival compared to not having taken part in treatment, meaning that it did not seem to have a sufficient protective effect against premature death.”

Death Rates Among Women

John expects that future studies will support the finding that females with AD had much higher annualized death rates compared to AD males in the general population. “We already know females tend to respond much stronger to toxins such as alcohol than males,” he said. “Women also seem to develop alcohol-attributable disease faster than men do. On the other hand we have only little knowledge about alcohol-attributable disease among women, since in most samples females constitute just one fourth to one third of the sample.”

That said, admitted John, the researchers were surprised by three findings. “One, a lack of longer survival after specialized AD treatment than after no treatment,” he said. “Here in Germany we provide very intense and specialized inpatient treatment on a long-term basis, and we expected that these patients had a better chance of longer survival than those not participating in such specialized treatment. We were also surprised by the finding that psychiatric co-morbidity did not seem to make any difference in survival time, although this is good news for those with an additional psychiatric diagnosis to AD. Third, we were surprised by the degree of the gender gap we found.”

Alcohol More Deadly Than Smoking

In short, said John, drinking seems to contribute more to very early death more than other main risk factors such as tobacco smoking.

“For example,” he said, “smoking-related death cases are more due to cancers which seem to occur later in life than many alcohol-attributable causes of death do. Furthermore, drinking can also contribute to other risky behaviours such as smoking, becoming overweight, and obesity. Alcohol is a dangerous product and should be consumed only within guidelines, no more than 12 grams for women on occasion and no more than 24 grams for men.”

October 20th, 2012  in Alcoholism No Comments »

Treatment reduces financial burden on alcoholic families

The financial effects of alcoholism on the family members of addicts can be massive, but little is known about whether treatment for alcoholism reduces that financial burden. A study of 48 German families published online today in the journal Addiction reveals that after twelve months of treatment, family costs directly related to a family member’s alcoholism decreased from an average of €676.44 (£529.91, US$832.26) per month to an average of €145.40 (£113.90, $178.89) per month. Put another way, average costs attributable to alcoholism decreased from 20.2% to 4.3% of the total pre-tax family income.

Among those 48 families, two of the largest family expenditures directly related to alcoholism were for alcoholic beverages (averaging €252.13/£197.51/$310.29 per month) and cigarettes (averaging €92.98/£72.83/$114.43 per month). Twelve months into treatment, those costs had reduced to €70.63 (£55.32, $86.92) and €64.21 (£50.29, $79.04) per month.

Financial Benefits of Treatment

Also, after twelve months of treatment, the average amount of time spent caring for the affected family member dropped from 32.2 hours per month to 8.2 hours per month. Using the minimum wage in Germany for employees in the nursing industry (€8.50 per hour), informal care provided by family members initially piled on an additional financial burden of €274.30 (£214.87, $337.66) per month, which reduced to €69.79 (£54.67, $85.88) per month after one year of treatment.

Even in cases of relapse, treatment for alcoholism still reduced the financial burden on families, but only by €65.22 (£51.09, $80.26) per month on average.

Lead author Dr. Salize (Central Institute of Mental Health, Mannheim, Germany) says, “We’re opening up an area of addiction research that doesn’t receive much attention. When they look at effects on families, addiction studies mainly focus on problems such as domestic violence and depression, not on the financial burden of caring for an alcoholic. But when health services and policymakers study the costs and benefits of treating alcoholism, they need to know that treatment has an immense financial effect not just on the alcoholic but also on his or her spouse, partner, children, and parents. The benefits of treatment reach well beyond the individual patient.”

October 1st, 2012  in Alcoholism No Comments »

African-American youth exposed to more alcohol advertising

African-American youth ages 12-20 are seeing more advertisements for alcohol in magazines and on TV compared with all youth ages 12-20, according to a new report from the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health. The report is available on CAMY’s website, www.camy.org.

The report analyzes alcohol exposure by type and brand among African-American youth in comparison to all youth. It also assesses exposure of African-American youth to alcohol advertising relative to African-American adults across various media venues using the most recent year(s) of data available.

Group’s Most Widely Used Drug

Alcohol is the most widely used drug among African-American youth, and is associated with violence, motor vehicle crashes and the spread of sexually transmitted diseases. At least 14 studies have found that the more young people are exposed to alcohol advertising and marketing, the more likely they are to drink, or if they are already drinking, to drink more.

“The report’s central finding—that African-American youth are being over-exposed to alcohol advertising—is a result of two key phenomena,” said author David Jernigan, PhD, the director of CAMY. “First, brands are specifically targeting African-American audiences and, secondly, African-American media habits make them more vulnerable to alcohol advertising in general because of higher levels of media consumption. As a result, there should be a commitment from alcohol marketers to cut exposure to this high-risk population.”

Overexposed to Booze Advertising

The report finds certain brands, channels and formats overexpose African-American youth to alcohol advertisements:

  • Magazines: African-American youth saw 32 percent more alcohol advertising than all youth in national magazines during 2008. Five publications with high African-American youth readership generated at least twice as much exposure to African-American youth compared to all youth: Jet (440 percent more), Essence (435 percent more), Ebony (426 percent more), Black Enterprise (421 percent more), and Vibe (328 percent more ). Five brands of alcohol overexposed African-American youth compared to all youth and to African-American adults: Seagram’s Twisted Gin, Seagram’s Extra Dry Gin, Jacques Cardin Cognac, 1800 Silver Tequila, and Hennessey Cognacs.
  • Television: African-American youth were exposed to 17 percent more advertising per capita than all youth in 2009, including 20 percent more exposure to distilled spirits advertising. Several networks generated at least twice as much African-American youth exposure to alcohol advertising than all youth: TV One (453 percent more), BET (344 percent more), SoapNet (299 percent more), CNN (130 percent more) and TNT (122 percent more).
  • Radio: African-American youth heard 26 percent less advertising in 2009 for alcohol than all youth on stations with the most advanced measurement data available; however, they heard 32 percent more radio advertising for distilled spirits. In these markets, four station formats delivered more alcohol advertising exposure to African-American youth than to African-American adults: Contemporary Hit/Rhythmic (104 percent more), Contemporary Hit/Pop (14 percent more), Urban (13 percent more) and Hot Adult Contemporary (43 percent more).

Negative Health Consequences

“Alcohol products and imagery continue to pervade African-American youth culture, despite the well known negative health consequences,” said Denise Herd, PhD, an associate professor with the University of California Berkeley School of Public Health who reviewed the report. “The findings of this report make clear immediate action is needed to protect the health and well-being of young African Americans.”

According to the U.S. Centers for Disease Control and Prevention’s Youth Risk Behavior Survey, about one in three African-American high school students in the U.S. are current drinkers, and about 40 percent of those who drink report binge drinking. While alcohol use and binge drinking tend to be less common among African-American adults than among other racial and ethnic groups, African-American adults who binge drink tend to do so more frequently and with higher intensity than non-African Americans.

In 2003, trade groups for beer and distilled spirits committed to placing alcohol ads in media venues only when underage youth comprise 30 percent of the audience or less. Since that time, a number of groups and officials, including the National Research Council, the Institute of Medicine and 24 state attorneys general, have called upon the alcohol industry to strengthen its standard and meet a “proportional” 15 percent placement standard, given that the group most at risk for underage drinking—12 to 20 year-olds—is less than 15 percent of the U.S. population.

October 1st, 2012  in Alcohol No Comments »

Moderate alcohol consumption linked to atrial fibrillation

Moderate alcohol consumption increases the risk of atrial fibrillation in older people with heart disease or advanced diabetes, found a study in CMAJ (Canadian Medical Association Journal).

“Moderate to high alcohol intake was associated with an increased incidence of atrial fibrillation among people aged 55 or older with cardiovascular disease or diabetes,” writes Dr. Koon Teo, McMaster University, Hamilton, Ontario, with coauthors. “Among moderate drinkers, the effect of binge drinking on the risk of atrial fibrillation was similar to that of habitual heavy drinking.”

Study of 30,000 People

The findings come from a large study involving more than 30 000 individuals aged 55 years or older from 40 countries who had a history of cardiovascular disease or advanced diabetes with organ damage. Data came from the ONTARGET or TRANSCEND trials, which enrolled people between November 2001 and May 2004 with a follow up period of 56 months. The mean age of participants was 66.4 years and 29.8% (9064) were women. Of the participants, 61.7% were classified as having low alcohol consumption (up to 1 drink per week), 36.6% moderate and 1.7% high (more than 2 drinks a day for women and more than 3 for men).

Moderate alcohol consumption was defined using the World Health Organization’s (WHO) recommended consumption levels of up to 2 drinks a day — or 1 to 14 drinks a week for women — and up to 3 drinks a day — or 1 to 21 drinks a week — for men. Binge drinking was classified as 5 or more drinks a day, regardless of whether someone was usually a low-, moderate- or high-level alcohol consumer.

Risk Is Considerable

Almost 79% of binge drinkers in the study (948 of 1204) fell into the moderate-consumption group.

There were 2093 new cases of atrial fibrillation during the follow-up period. The age- and sex-standardized incidence rate per 1000 person-years was 14.5 in the low-intake group, 17.3 in the moderate-intake group and 20.8 in the high-intake group. The increase in atrial fibrillation cases linked to higher alcohol consumption was found in each age group.

“Because drinking moderate quantities of alcohol was common in our study (36.6% of the participants), our findings suggest that the effect of increased alcohol consumption, even in moderate amounts, on the risk of atrial fibrillation among patients with existing cardiovascular disease may be considerable,” state the authors.

Binge Drinking Risks

Limited data from other studies indicates that binge drinking in healthy people may increase the risk of atrial fibrillation, although moderate drinking in healthy individuals does not appear to be linked to increased risk.

“Recommendations about the protective effects of moderate alcohol intake in patients at high risk of cardiovascular disease may need to be tempered with these findings,” the authors conclude.

October 1st, 2012  in Alcohol No Comments »