Substance Abuse News

Energy drinks, favored among young people for the beverages’ caffeine jolt, also play a lead role in several popular alcoholic drinks, such as Red Bull and vodka. But combining alcohol and energy drinks may create a dangerous mix, according to University of Florida research.

In a study of college-aged adults exiting bars, patrons who consumed energy drinks mixed with alcohol had a threefold increased risk of leaving a bar highly intoxicated and were four times more likely to intend to drive after drinking than bar patrons who drank alcohol only.

Eliminates Sedating Effects of Alcohol

The study appears in the April issue of the journal Addictive Behaviors.

“Previous laboratory research suggests that when caffeine is mixed with alcohol it overcomes the sedating effects of alcohol and people may perceive that they are less intoxicated than they really are,” said the study’s lead researcher Dennis Thombs, an associate professor in the UF College of Public Health and Health Professions’ department of behavioral science and community health. “This may lead people to drink more or make uninformed judgments about whether they are safe to drive.”

Experts believe that among college drinkers, as many as 28 percent consume alcohol mixed with energy drinks in a typical month.

The UF study is the first of its kind to evaluate the effects of alcohol mixed with energy drinks in an actual drinking environment, that is, at night outside bars. Research on college student alcohol use in campus communities has traditionally relied on self-report questionnaires administered to sober students in daytime settings, Thombs said.

Data for the UF study were collected in 2008 from more than 800 randomly selected patrons exiting establishments in a college bar district between the hours of 10 p.m. and 3 a.m. Researchers conducted face-to-face interviews with participants to gather demographic information and details on participants’ energy drink consumption and drinking behavior. Participants also completed self-administered questionnaires that asked
about their drinking history and intention to drive that night. Next, researchers tested participants’ breath alcohol concentration levels. Participants received feedback on their intoxication levels and advice about driving risk.

Wide Awake Drunks

Bar patrons who reported drinking alcohol mixed with energy drinks — 6.5 percent of study participants — were three times more likely to be intoxicated than drinkers who consumed alcohol only. The average breath-alcohol concentration reading for those who mixed alcohol and energy drinks was 0.109, well above the legal driving limit of 0.08. Consumers of energy drink cocktails also left bars later at night, drank for longer periods of time, ingested more grams of ethanol and were four times more likely to express an intention to drive within the hour than patrons who drank alcohol only.

Consumers of alcohol mixed with energy drinks may drink more and misjudge their capabilities because caffeine diminishes the sleepy feeling most people experience as they become intoxicated. It’s a condition commonly described as “wide awake and drunk,” said study co-author Bruce Goldberger, a professor and director of toxicology in the UF College of Medicine.

“There’s a very common misconception that if you drink caffeine with an alcoholic beverage the stimulant effect of the caffeine counteracts the depressant effect of the alcohol and that is not true,” Goldberger said. “We know that caffeine aggravates the degree of intoxication, which can lead to risky behaviors.”

The study, funded by the University of Florida Office of the President, raises a lot of questions and suggests topics for future research, Thombs said.

Unsafe Levels of Caffeine?

“This study demonstrates that there definitely is reason for concern and more research is needed,” he said. “We don’t know what self-administered caffeine levels bar patrons are reaching, what are safe and unsafe levels of caffeine and what regulations or policies should be implemented to better protect bar patrons or consumers in general.”

Thombs’ study is a very valuable addition to the existing body of research on the association of energy drink consumption and alcohol-related consequences, said Dr. Mary Claire O’Brien, an associate professor of emergency medicine and public health sciences at Wake Forest University who has studied the relationship between energy drink cocktails and high-risk behavior.

“His approach is unique because it was conducted in a natural drinking environment — college bars,” O’Brien said. “His results clearly support the serious concern raised by previous research, that subjective drunkenness may be reduced by the concurrent ingestion of caffeinated energy drinks, increasing both the likelihood of further alcohol consumption, and of driving when intoxicated.”

More alcohol sales sites in a neighborhood equates to more violence, and the highest assault rates are associated with carry-out sites selling alcohol for off-premise consumption, according to new research released today (Feb. 21) by two Indiana University professors.

Using crime statistics and alcohol outlet licensing data from Cincinnati, Ohio, to examine the spatial relationship between alcohol outlet density and assault density, Department of Criminal Justice professor William Alex Pridemore and Department of Geography professor Tony Grubesic found that off-premise outlets appeared to be responsible for about one in four simple assaults and one in three aggravated assaults.

Easier Alcohol Availability

The findings were released at the annual meeting of the American Association for the Advancement of Science in San Diego, Calif.

“A higher density of alcohol sales outlets in an area means closer proximity and easier availability to an intoxicating substance for residents,” Pridemore said. “Perhaps just as importantly, alcohol outlets provide a greater number of potentially deviant places. Convenience stores licensed to sell alcohol may be especially troublesome in this regard, as they often serve not only as sources of alcohol but also as local gathering places with little formal social control.”

Using different suites of spatial regression models, the researchers found that adding one off-premise alcohol sales site per square mile would create 2.3 more simple assaults and 0.6 more aggravated assaults per square mile. Increases in violence associated with restaurants and bars were smaller but still statistically significant, with 1.15 more simple assaults created when adding one restaurant per square mile, and 1.35 more simple assaults per square mile by adding one bar.

“We could expect a reduction of about one-quarter in simple assaults and nearly one-third in aggravated assaults in our sample of Cincinnati block groups were alcohol outlets removed entirely,” Grubesic noted. “These represent substantial reductions and clearly reveal the impact of alcohol outlet density on assault density in our sample.”

Alcohol Sales and Crime

The study examined 302 geographic block groups that encompassed all of Cincinnati, with each block group containing about 1,000 residents. Block groups are subdivisions of census tracks and represent the smallest unit available for socioeconomic analysis using data from the Census Bureau.

Crime statistics from January through June 2008 provided by the Cincinnati Police Department found 2,298 simple assaults and another 479 serious assaults had occurred in the study area during that time. The location of each of these criminal events was geocoded to show the precise location where they occurred. The researchers, using data from the Ohio Division of Liquor Control for Hamilton County, Ohio, then used the same geocoding techniques to spatially aggregate the city’s 683 unique alcohol sales outlets into those block groups. The arithmetic mean, or average, density of assaults was 69 per square mile, while the average density of alcohol outlets per square mile was 20.

The researchers pointed to possible implications from the research on both public policy and on future research within the field of criminology. Pridemore said ecological studies of alcohol and violence similar to this one, while appearing more and more over the past 20 years in journals of disciplines like public health, geography and epidemiology, have been rare in criminology journals.

Alcohol and Violence

“We believe that alcohol outlets, as a source of community-level variation in levels of interpersonal violence, deserve greater attention in the criminological literature,” he said. “The nature of our findings should encourage further investigation of the nature of the ecological association between alcohol, violence and other negative outcomes within communities.”

Grubesic said explanations for crime ecological theories like collective efficacy, social disorganization and social cohesion rely on elements like poverty, ethnic heterogeneity, residential mobility, anonymity of community members and willingness to intervene on another’s behalf, are difficult to remedy through public policy. That is not the case with alcohol outlet density, he said.

“Alcohol outlet density, on the other hand, is much more amenable to policy changes,” Grubesic pointed out. “Unlike other negative neighborhood characteristics that often seem intractable, regulating the density of outlets, and to some extent their management, can be readily addressed with a mixture of policies by liquor licensing boards, the police and government agencies that regulate land use.”

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

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

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

Social and Financial Influences

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

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

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

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

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

Alcohol Problems Don’t Go Away

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

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

Young men who believe that happiness declines with age are more likely to engage in risky health behaviors such as binge drinking. Their misguided negative view of the aging process may act as a disincentive to behave ’sensibly’ and encourage them to make the most of the present in anticipation of ‘miserable’ old age. These findings¹ by Dr. John Garry and Dr. Maria Lohan from Queen’s University Belfast, Northern Ireland, are published online in Springer’s Journal of Happiness Studies.

Although the harmful effects of excessive drinking, smoking, poor diet and lack of exercise are widely publicized, significant numbers of young people binge-drink, smoke, and avoid fruit and vegetables as well as regular exercise. Could it be that young people’s risky health behaviors are linked to their perception of declining happiness with advancing age?

Asked About Happiness

Garry and Lohan analyzed data from face-to-face interviews with over 1,000 citizens of Northern Ireland aged over 15 years. The participants were asked about their alcohol consumption, their fruit and vegetable intakes, whether or not they smoked, and how often they took part in vigorous exercise. The respondents were also asked to report how happy they currently felt, as well as to estimate how happy they expected to be at the age of 30 and 70. Those who were over 30 and/or 70 were asked to think back at how happy they were then. The authors also asked them to indicate how happy the average person of their age at age 30 is and how happy at age 70.

Young people wrongly believed that ageing is associated with a decline in happiness. Indeed, young people estimated that happiness declined with age, whereas in actual fact there was no difference between the self-reported happiness levels of young people and old people.

Just over half the respondents were categorized as binge drinkers – 59 percent of males and 45 percent of females. In particular, young men who were pessimistic about future happiness were more likely to binge-drink.

Risky Binge Drinking

The authors believe their findings could help inform health campaigns aimed at reducing risky health behaviors in young people. They conclude: “Our findings confirm, in the case of binge drinking by men, that risky health behavior in youth is associated with an underestimation of happiness in old age. It may be worthwhile to emphasize, to young men in particular, the positive impact on their lives of reducing alcohol and inform them about happiness in old age.”

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

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

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

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

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

Out of Control

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

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

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

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

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

Blocking the Stress Response

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

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

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

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

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

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

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

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

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

A.A. Can Relieve Depression Symptoms

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

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

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

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

Risks of Developing Alcohol Problems

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

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

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

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

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

But the current findings suggest that is not the case.

Don’t Let Children Drink

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

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

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

Drinking Begets More Drinking

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

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