Substance Abuse News

A new national study reveals that the rate of past month alcohol use (i.e., at least one drink in the past 30 days) among American Indian or Alaska Native adults is significantly lower than the national average for adults (43.9 percent versus 55.2 percent). The study, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), also shows that American Indian or Native Alaska adults have a rate of past month binge alcohol drinking (i.e., five or more drinks on the same occasion – on at least one day in the past 30 days) well above the national average (30.6 percent versus 24.5 percent). The level of past month illicit drug use was also found to be higher among American Indian or Alaska Native adults than the overall adult population (11.2 percent versus 7.9 percent).

Alcohol Treatment Needed

Among the study’s other significant findings:

• Eighteen percent of American Indian or Alaska Native adults needed treatment for an alcohol or illicit drug use problem in the past year, nearly twice the national average (9.6 percent).
• 1 in 8 (12.6 percent) American Indian or Alaska Native adults who were in need of alcohol or illicit drug treatment in the past year received it at a specialty facility – about the same as the national average (10.4 percent).
• American Indian or Alaska Native adults’ past month substance use rates drop significantly in older age groups – for example, illicit drug use levels drop from 25.4 percent in the 18 to 25 age group to 4.1 percent in those 50 and older. This pattern is also seen in the general adult population.

The study was developed as part of the agency’s strategic initiative on data, outcomes, and quality – an effort to create an integrated data strategy that informs policy makers and service providers on the nature and scope of behavioral health issues. It is one in a series of studies designed to provide more detailed information on substance abuse patterns and treatment needs existing within a wide range of population groups.

Support Services Needed

“Patterns of substance abuse vary somewhat among different segments of our society,” said SAMHSA Administrator Pamela S. Hyde, J.D. “Prevention, treatment and recovery support services are vitally needed within every community. We are using these studies along with on the ground experience to design and provide these services in a way that is accepted by the community and appropriate for individual needs.”

“We appreciate SAMHSA’s support of this study, which provides valuable findings that can be used for more targeted treatment programs and patient screening,” said Dr. Yvette Roubideaux, the Director of the Indian Health Service.

Summertime and the living is easy. But not too easy for parents whose children will head to college in the fall.

University of Rhode Island Psychology Professor Mark Wood, a nationally recognized alcohol researcher, wants parents to be aware that this is a time when teens tend to increase their alcohol consumption.

The URI expert advises parents to monitor their children–know where they are, whom they are with and what they are doing.

Monitoring Means Less Drinking

“This type of monitoring, particularly in combination with an emotionally supportive parenting style, is associated with less drinking and fewer alcohol-related problems across numerous studies,” Wood said.

“It is also important for parents to express clear disapproval of alcohol use and to provide clear and fair consequences associated with breaking the rules. Research shows this combination of factors decreases alcohol use and problems through adolescence and into college,” continued Wood who helps create interventions to reduce alcohol related-harm, particularly among college-age students. Results of his recent study bear this out.

Is Wood advocating that parents become helicopter parents–ones who hover over their children and their problems or experiences, especially when they are in college?

“We live in a era when students are texting and talking to parents, sometimes many times a day. Although the term helicopter parent does have a negative connotation, I think conversations about drinking are good whenever and wherever they occur,” said the researcher.

But is it too late for parents to begin monitoring teenagers after they have already graduated from high school?

“Most American teenagers begin to drink by age 15. By the time they go off to college, most have considerable drinking experience,” explained Wood. “Ideally, parents should be having conversations about alcohol throughout high school. But it’s never too late to begin an ongoing dialogue about drinking with teens.”

There is good reason to be concerned. It’s estimated that more than 1,800 college students die each year in car accidents and more than 750,000 are involved in alcohol related physical or sexual assaults.

Adolescents tend to increase their alcohol use the summer before entering college and during their first semester at college. This is also true of children who have been consistently monitored and emotionally supported. However, these children don’t increase consumption to the levels of kids who didn’t have that kind of parental involvement in high school.

Values, Attitudes and Expectations

“The protective effects that parents exert in high school continue to be influential into college even at a time when the kids have left the home. It’s the internalization of those values, attitudes, expectations that seem to continue to exert an effect,” said Wood.

Wood and his team applied some of their research findings to an intervention to reduce the increases in drinking and the negative consequences that typically occur during matriculation and into college. Results of the study were published in the June 2010 issue of the Journal of Consulting and Clinical Psychology.

In this study, which began in 2004, they recruited and randomly assigned 1,000 incoming freshmen to receive either a Brief Motivational Intervention (BMI) or a parent-based intervention, both, or an assessment-only control. The motivational intervention is considered to be the most effective individual alcohol prevention approach with college students.

In contrast to other BMI studies that have focused on heavier drinkers, the URI study recruited students whether they drank or not. In fact, about 28 percent of the 1,000 students in the study didn’t drink when they came to college.

Students met with an intervention provider who went over a tailored report compiled from information provided by the students about a range of factors, including their alcohol use patterns, consequences associated with use, and family history of alcohol problems. Students were recognized as responsible adults, and weren’t preached to or told not to drink.

Among other things, the report showed the student how his or her drinking compared to others of the same age and gender, correcting misperceptions students have about how much other students are drinking. For example, students often overestimate how much their peers are drinking, and correcting these misconceptions as part of motivational interventions has resulted in lower levels of alcohol use and problems.

Family History of Alcoholism

“A message that we would give a student who told us her father was an alcoholic is that we know that alcohol problems run in families. But it’s also important for you to know that this doesn’t mean that you’re destined to become an alcoholic. It just means that you have an increased risk of drinking problems based on family history,” says Wood.

The message is different with non-drinkers: “Congratulations, you’ve made the safest choice in terms of alcohol use at this point. One of the things we want to tell you is that there are more students like you than you think. We’d like to talk to you about ways that you can continue to make the safe choice around drinking now that you’re in an environment where there is more drinking.”

URI researchers followed up with the students in the spring of their freshman and sophomore years. The team found the intervention was successful for non-drinkers and drinkers. Students who received the BMI were significantly less likely to transition into heavy drinking or begin experiencing alcohol-related problems. For those who were already drinking, the BMI reduced heavy drinking and alcohol problems indirectly by altering students’ misperceptions about alcohol use.

Recovering addicts who avoid coping with stress succumb easily to substance use cravings, making them more likely to relapse during recovery, according to behavioral researchers.

“Cravings are a strong predictor of relapse,” said H. Harrington Cleveland, associate professor of human development, Penn State. “The goal of this study is to predict the variation in substance craving in a person on a within-day basis. Because recovery must be maintained ‘one day at a time,’ researchers have to understand it on the same daily level.”

Craving Triggers

Cleveland and his colleague Kitty S. Harris, director, Center for the Study of Addiction and Recovery, Texas Tech University, used data from a daily diary study of college students who are recovering addicts to identify the processes that trigger cravings and prevent some addicts from building a sustained recovery.

The researchers found that how addicts cope with stress — either by working through a problem or avoiding it — is a strong predictor of whether they will experience cravings when faced with stress and negative mood.

Coping Skills Important

“Whether you avoid problems or analyze problems not only makes a big difference in your life but also has a powerful impact on someone who has worked hard to stay away from alcohol and other drugs,” explained Cleveland. “When faced with stress, addicts who have more adaptive coping skills appear to have a better chance of staying in recovery.” The findings appeared in a recent issue of Addictive Behaviors.

Researchers supplied Palm Pilots to 55 college students who were in recovery from substance abuse ranging from alcohol to cocaine and club drugs. The students were asked to record the their daily cravings for alcohol and other drugs, as well as the intensity of negative social experiences — hostility, insensitivity, interference, and ridicule — and their general strategies for coping with stress.

“We looked at variations in the number of cravings across days and found that these variations are predicted by stressful experiences,” said Cleveland. “More importantly, we found that the strength of the daily link between experiencing stress and the level of cravings experienced is related to the participants’ reliance on avoidance coping.”

Stress Doubles Cravings

Statistical analyses of the survey data suggests that the magnitude of the link between having a stressful day and experiencing substance use cravings doubles for recovering addicts who cope with stress by avoiding it.

“We found that addicts who deal with stress by avoiding it have twice the number of cravings in a stressful day compared to persons who use problem solving strategies to understand and deal with the stress,” explained Cleveland. “Avoidance coping appears to undercut a person’s ability to deal with stress and exposes that person to variations in craving that could impact recovery from addiction.”

According to Cleveland, the findings suggest the impulse to avoid stress is never going to help recovering addicts because stressful experiences cannot be avoided.

“If your basic life strategy is to avoid stress, then your problems will probably end up multiplying and causing you more problems,” he added.

Researchers at Harvard-affiliated McLean Hospital have produced the first evidence that the opioid blocker extended-release injectable naltrexone (XR-NTX) is able to reduce the brain’s response to cues that may cause alcoholics to relapse.

In data presented at the annual meeting of the American Psychiatric Association, Scott Lukas, PhD, director of the Neuroimaging Center at McLean, located in Belmont, Mass., said the findings help in the understanding of how XR-NTX works in reducing the craving for alcohol and may potentially help predict which people will respond best to the drug.

Less Likely to Relapse

“These data are quite important since relapse remains a significant challenge in treating patients with alcohol dependence,” Lukas said. “It looks to us that XR-NTX can help people remain abstinent by reducing the importance of these cues so they are less likely to relapse.”

XR-NTX works by blocking opioid receptors in the brain and was approved for the treatment of alcohol dependence in 2006. XR-NTX is commercially available as Vivitrol®.

“We were trying to better understand the biological basis of how XR-NTX reduces alcohol consumption,” Lukas said. “These data clearly demonstrate that XR-NTX reduced craving response in the brain when patients were presented with alcohol cues.”

In the study, which has not yet been published, the researchers used brain imaging as a tool to document how XR-NTX works when a person is placed in a situation deemed risky for alcohol relapse.

A total of 28 alcohol-dependent individuals were tested with a BOLD (Blood Oxygen Level Dependent) fMRI scan while shown pictures of bottles or glasses of alcoholic beverages and exposed to odors of their particular alcoholic beverage of choice.

Testing Naltrexone Injections

Under double-blind conditions, fifteen of the subjects were given an injection of a XR-NTX and thirteen subjects were given a placebo injection. The study did not test the older form of naltrexone, which is taken daily in pill form.

Initially, the subjects were asked to self-report their cravings for alcohol after being exposed to the alcohol cues. All subjects reported that their cravings increased in the first few minutes after exposure to the cues.

However, those on XR-NTX reported that their cravings started to diminish after a few minutes, while those on placebo injection reported no such decrease in craving levels.

fMRI images also revealed that the pictures and odors induced sharply contrasting brain blood flow activation patterns. Scans were taken at baseline and again two weeks after the injection. Scans of subjects on placebo were virtually unchanged after two weeks. But those subjects on XR-NTX showed significant reductions in activation patterns in areas of the brain having to do with cognitive and emotional processing and reward circuitry on the second scan following exposure to the alcohol cues.

Responded Less to Alcohol Cues

“The areas in the brain associated with craving did not light up nearly as much in patients treated with XR-NTX compared to patients on placebo,” Lukas said. “These data suggest that those patients on XR-NTX were responding less strongly to the alcohol cues after being on the drug for only two weeks,” he added.

Lukas cautioned, “There is no single magic bullet, but having a choice of medications at our disposal gives physicians an increased chance to better treat a wide range of addictions.”

Understanding cravings and how medication can play a role in controlling them will help to improve treatment for patients with alcohol dependence.

Barbara McCrady and Elizabeth Epstein wanted to know whether cognitive behavior therapy worked better for alcohol-dependent women when delivered as couples therapy than when delivered as individual therapy. They reported recently that both treatment methods worked well, but women treated in couples therapy maintained their gains a bit better than those in individual therapy. Also, women suffering from depression in addition to alcohol-dependence did better in couples therapy. Their paper appeared recently in the Journal of Consulting and Clinical Psychology.

Epstein is an associate research professor at the Center of Alcohol Studies. McCrady, formerly a professor of psychology at Rutgers, now directs the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addictions.

Women Less Likely to Seek Treatment

Alcohol use disorders hit women particularly hard, physically and psychologically. Epstein and McCrady cite earlier studies’ findings that between 4 and 8 percent of women under age 44 are alcohol-dependent, that as many as 65 percent of alcohol-dependent women have some additional psychiatric disorder, and that women are less likely to seek treatment for alcoholism than men. Alcohol-dependent women have high rates of distressed marriages and not much support from members of their social networks when they try to break that dependence. Until recently, there has not been much research on unique treatments for alcohol use disorders in women.

McCrady and Epstein recruited 102 women with newspaper ads and referrals from other alcohol treatment programs. They were looking for women who were alcohol-dependent, married or in a committed relationship with a man for at least six months, and whose male partners were willing to participate in therapy.

Couples Therapy Helps

Both groups received 20 out-patient sessions of cognitive behavioral therapy over six months, for which the goal was abstinence from alcohol. Seven therapists, all trained both in individual and couples therapy, saw the clients. After the 20 sessions,, each participant received follow-up interviews on the phone and in person for another year. For each woman in each of the 18 months of the study, researchers calculated the percentage of days abstinent and the percentage of days of heavy (more than three drinks in a day) drinking.

Nearly half the women started abstaining before the first treatment session, the researchers wrote. For the first month of treatment, the abstinence rate for women still drinking in both groups rose sharply – more sharply for women in couples therapy, perhaps because they had a slightly lower rate of abstention to start with. During the year following treatment, the women in couples treatment reported fewer heavy drinking days than women in individual treatment.

Social Support Important

The researchers concluded that there is a widespread need for specific treatments for alcohol- dependent women, and that social support for change is important. However, not all women have spouses, and not all spouses are supportive. Epstein and McCrady are currently recruiting women for another study comparing individual and group therapy. Participants needn’t be married or in a committed relationship for this study. Interested participants can call 732 445- 0900 visit womenandalcohol.rutgers.edu. Learn more about other aspects of the research program and current opportunities for participating by clicking here.

These studies are funded by the National Institute of Alcohol Abuse and Alcoholism of the National Institutes of Health.

Women and men who engage in frequent heavy drinking report significantly worse health-related practices, according to a Kaiser Permanente Center for Health Research study in the journal Addiction Research & Theory.

For the study, researchers surveyed 7,884 members of the Kaiser Permanente Northwest integrated health plan in Oregon and Washington. They found that risky drinkers have attitudes and practices that may adversely affect their long-term health and that people who drink at hazardous levels were less likely than other categories of drinkers to seek routine medical care.

At-Risk Drinkers

Risky drinking was defined in three different ways to account for both short and long-term alcohol-related risks: 1) those who, on average, drank three or more drinks per day, 2) women who consumed four or more drinks during one sitting, or men who drank five or more drinks during one sitting, or 3) people identified as at-risk drinkers using a commonly used screening tool.

“The main finding here is that risky drinkers also engage in other behaviors–such as relieving stress with alcohol and cigarettes, not wearing seatbelts, unhealthy eating and not regularly seeing their doctors–that put their health at risk,” said study lead author Carla Green, a senior investigator at the Kaiser Permanente Center for Health Research. “Physicians should not only be concerned about patients’ heavy drinking, but also these other health-related practices.”

The study, funded by the National Institute on Alcohol Abuse and Alcoholism, is the first to examine the relationship between drinking patterns and health while taking into account a wide-range of other factors that might influence that relationship.

Drinking Patterns and Health

Those factors include diet, exercise, stress management, sleep practices, seat belt use, income, education, obesity, as well as feelings about seeing the doctor, skepticism toward medical care, and attitudes about personal ability to influence health.

“Our study found that men and women who drank the most had less collaborative relationships with their doctors and were more likely to dislike going to the doctor. They were also less confident they could change their own health-related practices and more likely to think health is a matter of good fortune,” Green said.

While the study clearly showed a negative relationship between health and daily, heavy drinking, it also found that moderate drinking was associated with better health. In fact, on a standard health status survey, people who drank one-to-three drinks daily reported slightly better health than all other categories of drinkers, including life-long abstainers, former drinkers, light drinkers (less than one drink a day) and heavier drinkers (three or more drinks per day). People who drank moderately were also more likely to have better health-related attitudes and practices, and more likely to seek routine medical care.

Moderate Drinkers Healthier

“Even after taking these other health-related attitudes and practices into account, there was still a small but independent relationship between moderate drinking and better self-assessed health,” said Michael Polen, study co-investigator at the Kaiser Permanente Center for Health Research. “Previous research has linked moderate alcohol drinking with cardiovascular benefits, so that might be the underlying reason moderate drinkers report better health. It’s also possible that there are additional factors we didn’t measure that account for this positive relationship.”

The study was conducted by reviewing mail-survey responses of 7,884 Kaiser Permanente members from 2002 and 2003. The survey was linked to two years of electronic health records and service use data to study how drinking patterns affect willingness to seek health care. Each of the members, aged 18 to 64, responded to a survey that measured physical and mental health as well as health-related attitudes and practices.

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.”

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.”