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.”

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.

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.

In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) and the American Society of Addiction Medicine (ASAM) published this definition for alcoholism:

“Alcoholism is a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic.”

A study by University of Washington psychologists shows some people continue to drink heavily because of perceived positive effects, despite experiencing negative effects such as hangovers, fights and regrettable sexual situations.

According to participants in the study, boosts of courage, chattiness and other social benefits of drinking outweigh its harms, which they generally did not consider as strong deterrents.

‘Not Going to Happen to Me’

The findings offer a new direction for programs targeting binge drinking, which tend to limit their focus to avoiding alcohol’s ill effects rather than considering its rewards.

“This study suggest why some people can experience a lot of bad consequences of drinking but not change their behavior,” said Kevin King, co-author and UW assistant professor of psychology.

“People think, ‘It’s not going to happen to me’ or ‘I’ll never drink that much again.’ They do not seem to associate their own heavy drinking with negative consequences,” he said.

The paper was published online May 30 in Psychology of Addictive Behaviors.

500 Students Surveyed

Nearly 500 college students completed an online survey measuring their drinking habits during the previous year. The survey assessed how often the participants had experienced 35 different negative consequences of drinking, such as blackouts, fights, hangovers, missed classes and work, and lost or stolen belongings, as well as 14 positive effects of drinking, including better conversational and joke-telling abilities, improved sexual encounters and more energy to stay up late partying and dancing.

The researchers also measured the participants’ beliefs about how likely all of these drinking consequences would happen again and how positive or negative they were.

Participants rated the upsides to drinking as more positive and likely to happen in the future, a finding the researchers call “rose-colored beer goggles.”

Keeps Getting Better?

“It’s as though they think that the good effects of drinking keep getting better and more likely to happen again,” said Diane Logan, lead author and a UW clinical psychology graduate student.

Respondents’ perceptions of drinking’s negative consequences differed according to how many bad experiences they had had. Those who experienced a small to moderate number of ill effects of drinking did not consider the experiences to be not so bad and did not think that they were any more likely to experience them again compared with students who hadn’t experienced them.

The researchers call this cognitive-dissonance reasoning. It leads to people, on the morning after a night of heavy partying, telling themselves “I’ll never drink that much again” or “I threw up that one time, but that’s not me; I won’t do it again.” Or, it may be that once a bad consequence of drinking happens, people think that it wasn’t really as bad as they initially thought, the researchers speculated.

But the participants reporting the most bad experiences rated the episodes as more negative and more likely to happen again. “Until high levels of negative consequences are experienced, participants aren’t deterred by the ill effects of drinking,” Logan said.

Focusing on Drinking Consequences

The findings have implications for alcohol intervention programs for college students, which tend to focus on how to avoid the negative consequences of drinking. “We should take into account how people don’t think of negative consequences as all that bad or likely to happen again,” Logan said, adding that factoring in how people view alcohol’s positive effects “might have a bigger impact” on drinking habits.

She suggests a risk reduction approach by helping people reduce their drinking such that they still get some of the positive effects while avoiding many of the negative and recommends training exercises to increase social skills in the absence of alcohol.

The National Institute on Alcohol Abuse and Alcoholism funded the study. Co-authors are Teague Henry, a UW psychology undergraduate student; Matthew Vaughn, a former UW psychology undergraduate student; and Jeremy Luk, a UW psychology graduate student.

It’s considered a rite of passage among young people – acting out their independence through heavy, episodic drinking. But a new University of Cincinnati study, the first of its kind nationally, is showing how binge drinking among adolescents and young adults could be causing serious damage to a brain that’s still under development at this age.

Researcher Tim McQueeny, a doctoral student in the UC Department of Psychology, is presenting the findings this week at the 34th annual meeting of the Research Society on Alcoholism in Atlanta.

Binge Drinking and the Brain

High-resolution brain scans on a sample of 29 weekend binge drinkers, aged 18 to 25, found that binge-drinking – consuming four or more drinks in one incident for females and five or more drinks for males – was linked to cortical-thinning of the pre-frontal cortex, the section of the brain related to executive functioning such as paying attention, planning and making decisions, processing emotions and controlling impulses leading to irrational behavior.

McQueeny examined the brain’s gray matter, the parts of brain cells that do the thinking, receiving and transmitting of messages. “We have seen evidence that binge drinking is associated with reduced integrity in the white matter, the brain’s highways that communicate neuron messaging, but alcohol may affect the gray matter differently than the white matter,” he says.

The pilot study examined whether the researchers could see a relationship between gray matter thickness and binge drinking among college-aged young adults. They found that greater number of drinks per binge is associated with cortical thinning. McQueeny is now interested in pursuing future research to examine whether binge drinking is affecting the brain’s gray matter and white matter differently, or if they’re both equally affected.

Brain Is Still Growing

“Alcohol might be neurotoxic to the neuron cells, or, since the brain is developing in one’s 20s, it could be interacting with developmental factors and possibly altering the ways in which the brain is still growing,” he says.

The findings affect a significant population. A publication from the National Institute on Drug Abuse reports that 42 percent of young American adults between 18 and 25 have engaged in binge drinking.

McQueeny adds that the depressant effects of alcohol emerge later in life, so for young adults, the effect of alcohol can be very stimulating and activate tolerance over time.

“In the past, in terms of what’s known about the physical toll of alcohol, the focus on neurobiology has been in pathological populations and adult populations who were disproportionately male, so there was a significant gap in research in terms of when people started risky drinking. We’re looking at developmental aspects at an age when binge drinking rates are highest, and we’re also looking at gender effects,” says McQueeny. “There might actually be indications of early micro-structural damage without the onset of pathological symptoms such as abuse, or dependence on alcohol.”

Resonsible Drinking Suggested

McQueeny’s advisor, UC Psychology Professor Krista Lisdahl Medina, served as senior author on the paper. She adds, “Our preliminary evidence has found a correlation between increased abstinence of binge drinking and recovery of gray matter volume in the cerebellum. Additional research examining brain recovery with abstinence is needed.”

In terms of educating young adults about responsible drinking, Medina says there appear to be better efforts about communicating the dangers of drinking and driving. “However, people can still be doing damage to their brain as a result of the prevalence and acceptance of binge drinking. There is also evidence that drinking below the binge level may be less harmful,” she says.

The high-resolution imaging was conducted at UC’s Center for Imaging Research.

The research was supported by a $300,000 grant awarded to Medina’s lab by the National Institute on Drug Abuse. McQueeny was also awarded a University Research Council Summer Graduate Fellowship.

While alcohol has a wide range of pharmacological effects on the body, the brain is a primary target. However, the molecular mechanisms by which alcohol alters neuronal activity in the brain are poorly understood. Participants in a symposium at the June 2010 annual meeting of the Research Society on Alcoholism in San Antonio, Texas addressed recent findings concerning the interactions of alcohol with prototype brain proteins thought to underlie alcohol actions in the brain.

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

Effects of Alcohol on the Brain

“Alcohol is the most common drug in the world, has been used by diverse human communities longer than recorded history, yet our understanding of its effects on the brain is limited when compared to other drugs,” said Rebecca J. Howard, a postdoctoral fellow at The University of Texas at Austin Waggoner Center for Alcohol & Addiction Research and corresponding author for this study.

Howard explained that neuroscientists have discovered how marijuana, cocaine, and heroin each bind to a special type of protein on the surface of brain cells, fitting like a key into a lock to change that protein’s normal function. Yet alcohol has special properties that make it difficult to characterize its lock-and-key binding in detail, for example, alcohol is much smaller than other drugs, and appears to interact with several different types of proteins.

“The adverse effects of alcohol abuse are devastating on a personal level and on a societal level,” added Gregg Homanics, a professor of anesthesiology and pharmacology & chemical biology at the University of Pittsburgh. “Alcohol abuse costs our society more than the costs of all illegal drug abuse combined. For many years, most investigators thought that alcohol exerted nonspecific effects on the brain and simply perturbed neuronal function by dissolving in the membranes of nerve cells. However, our understanding of alcohol action has dramatically shifted in the last 10 to 15 years or so. There is now solid experimental evidence that alcohol binds in a very specific manner to key protein targets in the brain to cause the drug’s well known behavioral effects. This review summarizes some of the most recent research.”

Recent Alcohol Research

Some of the key points were:

Combining X-ray crystallography, structural modeling, and site-directed mutagenesis may be better suited to studying alcohol’s low-affinity interactions than traditional techniques such as radioligand binding or spectroscopy.

“One major problem in studying alcohol binding to brain proteins is that the alcohol key does not fit very tightly into any particular protein lock,” said Howard. “That is, alcohol has a ‘low affinity’ for proteins, compared to how other drugs interact with their own protein targets. We think this is one reason it takes such a large quantity of alcohol to affect the brain: whereas users of cocaine or heroin may consume just a few milligrams at a time, a person drinking a shot of strong liquor consumes about 1,000 times that much alcohol (several grams). The low affinity of alcohol for its protein targets [also] makes it difficult to study by traditional methods that rely on detecting stable drug-protein complexes over a long period of time.”

Some common themes are beginning to emerge from a review of diverse proteins such as inwardly rectifying potassium, transient receptor potential, and neurotransmitter-gated ion channels, as well as protein kinase C epsilon.

Alcohol Targets in the Brain

“It is now very clear that hydrophobic pockets exist in the structure of various brain proteins and alcohols can enter those pockets,” said Homanics. “Alcohols interact with specific amino acids that line those pockets in a very specific manner.”

In particular, evidence is emerging that supports characteristic, discrete alcohol binding sites on protein targets.

“Different drugs bind to different types of proteins on the surface of brain cells, each fitting like a key, or drug, into a lock, or binding site, on a protein to change its normal function,” explained Howard. “Understanding the exact shape of that lock and key helps us to understand how individuals with special mutations may be affected differently by drugs, and can help scientists design new medicines to help people with drug abuse or other problems.”

The Brain’s Binding Sites

“I feel that there is now overwhelming evidence that specific alcohol binding sites exist on a variety of brain protein targets,” added Homanics. “This is significant because we can now focus on defining these sites in greater detail, ultimately at the level of each atom involved. This will allow for, one, a more complete understanding of the molecular pharmacology of alcohol action, two, the discovery of similar sites on other important brain proteins, and three, the rational design of drugs that can selectively target these binding sites.”

“Our review summarizes very recent advances in understanding the molecular details of alcohol binding sites, which now include human brain targets, not just metabolic enzymes and receptors from other species,” said Howard. “This information will give researchers new opportunities to characterize human mutations and design new medicines. Furthermore, common themes emerging about alcohol binding sites may help scientists identify important binding sites in other important brain proteins.”

Highly Selective Targets

“In other words,” said Homanics, “alcohol exerts its effects via binding sites on target molecules just like all other drugs we know about. There is now solid evidence from several different putative alcohol targets using several different techniques that alcohol interacts with specific brain targets in a highly selective manner. This is particularly important for more senior clinicians and researchers that were trained years ago when the predominant theory of alcohol action was via nonspecific effects on the nervous system.” Both Howard and Homanics are hopeful that this research will aid the development of therapies and treatments for individuals with alcohol problems.

“Great progress is being made in understanding how alcohol exerts its effects on the brain at the molecular level,” noted Homanics. “Understanding how alcohol affects brain proteins on a molecular level is essential if we are to effectively develop rational treatments to combat alcohol use disorders.”

A new report shows that alcohol dependence is four times more likely to occur among adults with mental illness than among adults with no mental illness (9.6-percent versus 2.2-percent).

Based on a nationwide survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) the report also shows that the rate of alcohol dependency increases as the severity of the mental illness increases. For example, while 7.9-percent of those with mild mental illness were alcohol dependent, 10-percent of those with moderate mental illness and 13.2-percent of those with serious mental illness were alcohol dependent.

“Mental and substance use disorders often go hand in hand. This SAMHSA study adds to the evidence of this connection,” said SAMHSA Administrator Pamela S. Hyde, J.D. “Co-occurring mental illness and substance use disorders are to be expected not considered the exception. Unfortunately, signs and symptoms of these behavioral health conditions are often missed by individuals, their friends and family members and unnoticed by health professionals. The results can be devastating and costly to our society.”

Behavioral Health Issues

The SAMHSA Spotlight report, “Alcohol Dependence is More Likely among Adults with Mental Illness than Adults without Mental Illness” was developed as part of SAMHSA’s strategic initiative on data, outcomes, and quality – an effort to inform policy makers and service providers on the nature and scope of behavioral health issues. The report is based on data from the 2009 National Survey of Drug Use and Health – a state-of-the-art scientific survey of a large representative sample of people throughout the United States.

The full report is available on the web.