Middle class over 45-year-olds now the most frequent drinkers

The middle class people over the age of 45 are now the most frequent drinkers in England, new NHS figures show.

The findings add to growing concern over middle class drinkers and the damage their habits are doing to their bodies.

Earlier this year a report by the National Audit Office, the Government watchdog, warned that 10 million Britons were now drinking to "hazardous" levels.

A survey conducted by the NHS Information Centre shows that 30 per cent of men and 19 per cent of women in the highest earning bracket admitted that they had drunk alcohol five nights or more in the previous week, twice as much as in the lowest wage bracket.

The middle aged were also much more likely than young people or thirtysomethings to drink frequently.

The highest rate was among men aged 55 to 64, 33 per cent of whom said that they had drunk five or more days out of the last seven.

Among women, 19 per cent of 65 to 74-year-olds admitted that they drank that often.

By contrast just 12 per cent of male and 5 per cent of female 16 to 24-year-olds said that they drank that frequently.

And overall 22 per cent of men and 13 per cent of women said that they had gone without alcohol for two days or less in the previous week.

While previous studies have concentrated on younger binge drinkers this is the first to suggest so starkly that middle class over 45-year-olds top the league table for frequent drinking.

The survey also found that levels of obesity have almost doubled in 14 years, from 16 per cent of men and 13 per cent of women in 1993 to 24 per cent of both sexes in 1997.

The breakdown of the figures on alcohol contained in the annual Health Survey for England report also show that almost one third of men and more than one quarter of women admit they drank excessively at least one day in the previous week.

It also discloses that few people know the recommended daily alcohol limits.

Men are advised to drink no more than three to four units a day, the equivalent of two pints of beer, and women two to three glasses of wine, the amount contained in one and a half standard glasses of wine.

Less than a third of people knew their safe limits, the study shows.

The survey also showed that while most knew that they should be eating five portions of fruit and vegetables every day, only 14 per cent of men and 11 per went of women knew how much should be contained in a portion, the survey also found.

Dr Mark Davies, medical director of the NHS Information Centre and a practising GP, said it was of "concern" that messages of safe alcohol intake, as well as those on exercise levels and healthy eating, did not seem to be getting through to all sections of the population.

Andrew Lansley, the shadow health secretary, said: "Labour's neglect over issues like obesity and alcohol abuse will leave a terrible legacy for the next Government to try and fix" and called for urgent action on public health problems.
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source: Telegraph

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Binge Drinking Clogs Arteries With Plaque

The specific pathway through which binge drinking contributes to clogged arteries has been identified by University of Rochester Medical Center researchers.

Alcoholic beverages contain ethanol, which is mostly converted into acetaldehyde. The Rochester team found that binge drinking-related levels of acetaldehyde make immune cells called monocyctes more likely to stick to blood vessel walls and cause inflammation that contributes to blood vessel blockage — atherosclerosis.

The study contributes to a growing body of evidence that drinking patterns have as much, or more, impact on cardiovascular disease risk than the total amount of alcohol consumed. The findings also may help efforts to develop new treatments to counter atherosclerosis, which can lead to heart attack and stroke, the researchers said.

“Factors like binge drinking have been linked to increased risk for heart disease, and the newer inflammatory model is beginning to explain how,” study leader John Cullen, an assistant professor in the department of surgery, said in a medical center news release. “One of our experiments found that acetaldehyde, at levels found in the blood after binge drinking, increased the number of monocytes that can adhere to cells lining blood vessels by 700 percent.”

The study was published in the current issue of the journal Atherosclerosis.

Binge drinking means having five or more drinks for men and four or more drinks for women in two hours, according to the U.S. National Institute on Alcohol Abuse and Alcoholism. Some studies have suggested that an irregular pattern of heavy drinking increases the risk of heart attack about two-fold.

An estimated 65 percent of Americans drink alcohol, and 15 percent reporting binge patterns, the researchers said.
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source: health.com

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Group pursues rules to discourage alcohol abuse

A group that spent 10 months reviewing Wyoming's alcohol laws advocates increasing state alcohol taxes and using the money to fund programs aimed at cutting underage and binge drinking.

The Wyoming Prevention Framework Communities group also recommended to state lawmakers that the state require mandatory training for alcohol servers and ban sales to drunk people.

The group, which is made up of representatives from all 23 Wyoming counties and the Wind River Indian Reservation, released its report Thursday.

Binge and underage drinking are two of the state's top health issues, according to Ernie Johnson, a University of Wyoming criminal justice instructor who managed the review effort.

"We have minimized the concerns for too long," he said.

The report recommends "substantially" increasing the tax on all alcohol products to equal the national average, with top priority going to a beer tax hike. Beer in Wyoming is now taxed at 2 cents a gallon - the lowest in the nation. The national average is 26 cents a gallon.

The group acknowledged that the tax hike is the most controversial recommendation in the report.

"It also has the greatest potential for generating and providing much-needed resources for Wyoming communities," the report states.

In advocating for the higher tax, the report notes that Wyoming's current tax rate hasn't changed since it was set in 1935.

The report recommends creating a system for providing local governments with the tax money in order to address binge and underage drinking. However, there wasn't consensus among the review group on the best way to achieve those ends.

Mike Moser, executive director of the Wyoming State Liquor Association, opposed raising alcohol taxes when he met with the group in May. Doing so would punish responsible drinkers along with people who abuse alcohol, he told the group.

The report suggests mandatory server and owner training as ways to cut down on the sale of alcohol to underage drinkers and people who have already had too much to drink.

Liquor retailers, working with the state's Liquor Distribution Division, already offer a training program on serving alcohol responsibly. However, Wyoming law does not require servers, managers or owners to participate.

The report offered statistics showing that most of the citations and infractions handed out during alcohol stings went to people who hadn't received server training.

The review group also recommended legislation that would ban alcohol sales to drunk people and prohibit drink specials that promote excessive drinking. The report cited research showing such laws can reduce alcohol-related problems, like car crashes, if they are adequately enforced.

Wyoming is one of three states that doesn't have a law prohibiting alcohol sales to drunk people.
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source: Billings Gazette

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Half of Young Adults Have Mental Disorder

Nearly half of young adults may suffer from a mental disorder such as alcohol abuse, depression and anxiety, and nearly one in five suffer from a serious personality disorder.

But according to new research published yesterday, fewer than a quarter of those young adults who do have mental concerns seek treatment for them.

And to check on whether such mental health concerns
might be triggered by attending college or not, the researchers compared those attending and not attending college and found similar rates of psychiatric illnesses among the two groups. This suggests that the transition from adolescence to adulthood can trigger the onset of a mental health problem regardless of setting.

The researchers analyzed data from over 5,000 young adults aged 19 to 25 years old from the
National Epidemiologic Survey on Alcohol and Related Conditions. Carlos Blanco, M.D., Ph.D., of the New York State Psychiatric Institute and Columbia University, and his colleagues analyzed the data to compare the mental health of those enrolled in college at least part-time with those not attending college during the previous year.

The researchers interviewed and assessed for psychiatric disorders those attending (2,188) or not attending (2,904) college during the previous year.

A total of 45.8 percent of college students and 47.7 percent of young adults not in college met the criteria for at least one psychiatric disorder.

The most common disorders in college students
were alcohol use disorders (20.4 percent) and personality disorders (17.7 percent), whereas those not in college most frequently met criteria for personality disorders (21.6 percent) and nicotine dependence (20.7 percent).

College students were less likely to have a diagnosis of drug use disorder, nicotine dependence or bipolar disorder and were less likely to have used tobacco. However, their risk of alcohol use disorders was significantly greater.

Treatment rates were low for all psychiatric disorders. College students were significantly less likely to receive treatment for alcohol or drug use disorders than those not in college.

“In view of the high prevalence and low rate of treatment of alcohol use disorders in college students, greater efforts to implement screening and intervention programs on college and university campuses are warranted,” the authors write. “The centralized delivery of campus student health services might offer an advantageous structure for carrying out such screening and interventions.”

Overall, the authors note, the rate of psychiatric disorders is high among young adults, who are at a vulnerable stage of development.

“The vast majority of disorders in this population can be effectively treated with evidence-based psychosocial and pharmacological approaches,” they conclude.

“Early treatment could reduce the persistence of these disorders and their associated functional impairment, loss of productivity and increased health care costs. As these young people represent our nation’s future, urgent action is needed to increase detection and treatment of psychiatric disorders among college students and their non–college-attending peers.”
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source: Psychcentral.com

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Extended-release naltrexone, treatment for alcohol dependence, improves quality-of-life measures

Most studies examining the impact of alcohol-dependence (AD) treatment on quality-of-life (QOL) have looked at psychosocial treatments. This study looked at the impact of pharmacotherapy on QOL, specifically, the effects of extended-release naltrexone (XR-NTX), a once-a-month injectable formulation for the treatment of AD. Results showed significant improvements in the QOL areas of mental health, social functioning, general health, and physical functioning.

Results will be published in the February 2009 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Alcohol dependence is a chronic and disabling disorder," said Helen M. Pettinati, professor of psychology in the department of psychiatry, and director of the division of treatment research at the University of Pennsylvania School of Medicine. "Heavy drinking is associated with broad impairments in health-related QOL, with the largest impact typically found for mental health and social functioning."

XR-NTX (Vivitrol™) is a once-a-month injectable formulation for AD treatment; its 380 mg dose has been FDA-approved since 2006. Daily oral NTX doses are also available, typically at 50 mg or 100 mg a day.

"If naltrexone is taken orally for 30 days, this translates to a total monthly dose of 1,500 mg or 3,000 mg," explained Pettinati, who is also corresponding author for the study. "When compared to the once-a-month 380 mg injectable dose approved by the FDA and the only dose available clinically, we can see what appears to be a hefty difference in the amount of naltrexone given over a month's period to a single individual when dosed daily versus injection. However, this 'lower' injectable dose does not appear to compromise efficacy, likely due to different and more efficient pharmacokinetic properties in the injectable formulation."

"The important issue is that if you can change people's drinking patterns, then you can also change people's QOL," observed Allen Zweben, professor and associate dean for academic affairs and research in the school of social work at Columbia University. "Pharmacotherapy has never really looked at QOL vis-à-vis drinking behavior, but it would seem that the FDA is interested in learning how people's changes in drinking can have an impact on their QOL. There's an implication that QOL changes naturally, but in this study Dr. Pettinati actually looked at and measured QOL as a factor."

The researchers randomly assigned 624 AD patients (423 males, 201 females) to one of three groups during 24 weeks of treatment – XR-NTX at 380 mg (n=205), XR-NTX at 190 mg (n=210), or placebo (n=209) – in conjunction with a standardized psychosocial intervention. QOL was assessed using the Medical Outcomes Study 36-item short-form health survey, administered at baseline and then at four-week intervals during treatment.

"There were three main findings from this study," said Pettinati. "First, the AD sample showed impairments in QOL at pre-treatment compared with population norms, especially in mental-health and social functioning. Second, the XR-NTX 380 mg group showed meaningful and significant improvements compared to the placebo group in the QOL domains of mental health, social functioning, general health, and physical functioning. Third, reductions in drinking from pre-treatment levels were correlated with improvements in QOL."

"These finding reinforce the notion that treatment of alcoholism, whether it's by medication or psychotherapy, does work," said Zweben. "Medication thus becomes another option available to people. These findings also have implications for the issue of compliance, in that high compliance rates might have something to do with the fact that people improve their drinking as well as their QOL."

It is one thing to believe that treatment reduces drinking and that time abstinent from alcohol can lead to increased QOL improvements, said Pettinati. "It is another to show this connection with new pharmacotherapies as they become available to our AD patients."

"In terms of treatment options," said Zweben, "this study shows that pharmacotherapy may be very cost-effective. You don't necessarily have to have a separate intervention to deal with QOL issues – whether more intensive psychotherapy, or family therapy – you may be able to use one intervention to reduce drinking, and improve QOL. This study also has implications for using medication as an option. A lot of people don't believe medication has any basis in alcohol treatment, that 'alcohol is a chemical already so why are you prescribing more chemicals?' It is almost a bias against medications. These results help to reduce some of the stigma attached to using medication in terms of alcohol treatment."

Zweben noted, however, that these findings need to be replicated in future studies, that the patients examined were seeking treatment –differentiating them from the more general population of AD individuals – and that 35 to 37 percent of the patients did not receive all six injections.
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Source: Alcoholism: Clinical & Experimental Research

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Turkey and youth drinking

When you think of Thanksgiving, turkey, football games and getting together with family usually comes to mind. But what also happens at Thanksgiving is an excess of youth drinking.

Officer Phil Powers, Hopkinton's school resource officer, said that in his 21 years on the police force he has found that the Wednesday evening before Thanksgiving is the busiest drinking night of the year for youth. It's busier than New Years Eve or graduation. And the problem is both with underage drinkers, many home from college for the first time, and with young legal drinkers in their twenties who are getting together with old high school friends and end up drinking to excess. Unfortunately, in too many cases these young people also get in a car and drive.

As parents, we all want to keep our kids safe. So what can you do?

# For kids under 21, have a conversation with them about your expectations about drinking; be clear that the law is no drinking until 21 and that you expect that they will follow it. This is critically important for kids who are coming home from college where there may be a different level of tolerance for underage drinking. Know where they are going and be there to check in with them when they get home. And never provide alcohol to anyone under 21; it's against the law.

# For kids over 21, talk to them about responsible drinking and the dangers of drinking till you are intoxicated when poor decisions are made about everything from driving to sexual activity. Reinforce the importance of identifying a designated driver before anyone starts drinking. Be sure they understand that it is illegal to buy liquor for anyone under 21 and that they can be criminally and civilly prosecuted if a problem occurs.

# For all kids, let them know that if they encounter a problem and can't get home safely, then you are always willing to come get them. Traffic crashes are the number one killer of teens and over one third of teen traffic deaths are alcohol related. Be a positive role model in your own use of alcohol. Kids listen to what you say but they also are influenced strongly by how you behave.

To help bring awareness to this problem, the beFREE! Project held a Sticker Shock campaign this past Wednesday in two retail stores, Colella's Supermarket and Hopkinton Wine and Spirits. BeFREE! youth with adult chaperones placed stickers on multi-packs of beer, wine coolers, and other alcoholic beverages that appeal to young drinkers. The stickers read "Hey You!! It is illegal to provide alcohol to people under 21!" Preventing underage drinking is everyone's responsibility and we need to work together to reduce underage access to alcohol and to teach young adults over 21 how to drink responsibly, if they choose to drink.

Studies show that talking to your kids about alcohol does make a difference in their behavior. So take a few minutes before this holiday to let your kids know your expectations, even if you have said it before. They need a reminder!
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SOURCE: MetroWest Daily News

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Genetic Trait Linked to Alcoholism

Variations in the genetic makeup of alcoholics may affect how much they drink, a new study suggests. And the key might be the brain's control of serotonin, a mood-influencing neurological chemical.

The research could potentially help doctors understand who might be at highest risk of becoming an alcoholic, and then treat that person, said study co-author Ming D. Li, head of neurobiology at the University of Virginia.

Li added that the research is unique, because it shows that a single gene variation is connected to a kind of behavior -- alcoholism.

The genetic blueprint that people inherit from their parents accounts for an estimated 40 percent to 50 percent of a person's risk of becoming alcoholic, said Dr. Robert Philibert, director of the Laboratory of Psychiatric Genetics at the University of Iowa.

The interplay between genetic makeup and environmental factors is responsible for the rest of the risk, said Philibert, who's familiar with the new study's findings.

"This study really takes the next step down the line," he said, in understanding the role that genes play in alcoholism.

For the study, the researchers looked at the DNA of 275 alcoholics who had sought treatment. Almost 80 percent were men, and all were of European descent. The researchers found that differences in the genes that affect serotonin levels in the brain coincided with the amount of alcohol consumed by the drinkers.

The findings were published online Nov. 20 and were expected to be in the February 2009 issue of Alcoholism: Clinical & Experimental Research.

Scientists think serotonin, a neurotransmitter, is crucial to human moods and emotions as well as things like sleep. Low levels of serotonin can lead to depression; some antidepressants aim to help the brain do a better job of processing serotonin.

"We know that serotonin is critical to maintaining a positive sense of self and for controlling our anxiety," Philibert said. That could explain a possible connection between serotonin levels and alcoholism, he added.

Li cautioned, however, that it's unlikely that a single genetic trait by itself would make someone more susceptible to alcoholism. It's more likely that a genetic variation works with other genes to raise the risk, he said.

Philibert said research might lead to a day when doctors could look at an alcoholic's genetic traits and discover whether antidepressants could help that person.
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source: U.S.News & World Report

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Grants to help tackle binge drinking

Nineteen communities across Australia will share $3.6 million from the federal government to tackle binge drinking.

The first round of community grants to fight excessive drinking was part of a $53 million government initiative, Health Minister Nicola Roxon said on Monday.

The grants went to grassroots projects including programs that offered alternative activities to pubs, a safe party initiative and a post-formal mystery tour for high school students.

"We in the Rudd government do understand that binge drinking is a problem," Ms Roxon said.

Ms Roxon said 10 per cent of 12-17 year olds were binge drinking every week.

The number of young women aged 18-24 who were hospitalised because of alcohol had doubled in the last eight years, and more than 750,000 Australians were physically abused last year by people under the influence.

"Not only does it hurt our society it hurts the economy as well," Ms Roxon said, adding the social cost of alcohol misuse was estimated at $15 billion each year.

Labor has committed $14.4 million to grassroots grants, as well as $19 million for early intervention and $20 million for an advertising campaign.

Ms Roxon said the states needed to agree on rules for the responsible service of alcohol and pub and hotel lockouts.

"There are different rules that apply across the states and territories," she said.

"We believe this is a national problem and the community would be better served by there being national consistency.

"But that involves health ministers and police ministers, it involves each jurisdiction, (and) some are very wedded to theirs being the most successful one, others want to see the evidence that's coming in from the different states and territories that have been trialling their lockouts," she said.
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source: The Age

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Study: Drinking alcohol shrinks brain size

A recent study shows that alcohol consumption, even in moderation, might shrink brain size.

The study, conducted by Carol Ann Paul at the Boston University School of Public Heath, tested 1,839 people ranging in age from 33 to 88. The participants were asked how much they drank per week and underwent an MRI procedure to measure their brain volume.

Results show a 1.5 percent difference in the total brain volume of a non-drinker to that of a heavy drinker. Heavy drinkers were defined as those who consumed 14 or more drinks a week.

Moderate drinking, which includes the amounts that have been shown to prevent heart disease, also resulted in a smaller brain volume than that of a non-drinker.

"There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume," the authors of the study wrote.

"I don't think it is going to change [what I do]," said Bryant Kubik, a junior in communications. "As you get older, your brain capacity is going to shrink anyway."

Research shows that as people age, the brain sees a small amount of natural brain shrinkage, about 2 percent for every 10 years, but greater amounts of shrinkage in certain areas of the brain have been linked to diseases such as dementia and Alzheimer's disease.

Kubik said he was not surprised by the results of the study. "If you drink a case of Natty Light a day, you're probably not going to be doing too good," he said.

Kubik and Ben Fox, a senior in theater, agreed that this information was not going to have much of an effect on college life.

"In a college atmosphere they're still going to do what they do," Fox said. "They'll still party and jump in Mirror Lake on Michigan Week and I'll probably be one of them."

Seventy-one percent of OSU students drink once a week or less, according to statistics from the Student Wellness Center.

Participants in the study reported low overall alcohol consumption and that men were more likely to be moderate or heavy drinkers than women.

Despite men being more likely to drink, the association between drinking and brain shrinkage was stronger among women.

The findings are published in the October issue of Archives of Neurology.
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source: http://www.thelantern.com

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Alcohol still the curse of the Cape

Alcohol is by far the most widely abused substance in the province and also accounts for 57 percent of road accidents, far higher than the rest of the country.

These figures were part of a collaborative report by the Medical Research Council, the Humans Sciences Research Council, and the University of Cape Town on substance abuse trends in the Western Cape, which reviewed studies conducted since 2000.

Professor Charles Parry of the MRC said Friday urgent intervention was needed to curb the misuse of alcohol.

"We need to counter advertising by the industry. Alcohol ads have to be restricted to late night when children are not watching TV, there must be signage at the point of sale on the harm caused by abusing alcohol, communities need to enforce the closure times of outlets in their areas, including shebeens, and there should be an absolute ban on novice drivers drinking and driving for at least three years."

Parry said the trauma units should steer drunken patients to intervention programmes.

He also wants to see the establishment of an alcohol health promotion foundation, to be funded by the liquor industry.

It could send messages on the harmful effects of alcohol misuse, offer alternative enterprises to shebeen owners, and run intervention programmes in communities.

The collaborative report was presented recently at a substance-abuse conference hosted in Cape Town by the provincial departments of health and social development.

It showed that alcohol remained a significant substance of abuse in the province but was not often a key focal point for prevention and treatment services.

This was despite the fact that alcohol abuse placed a tremendous burden on the health and social welfare sectors in both urban and rural areas.

Studies, including an HSRC household survey, pointed to higher levels of problem drinking among coloured communities. The research council said 18 percent of coloureds abuse alcohol compared to 11 percent of blacks, 7 percent of whites and 1 percent of Indians.

Cape Town has more alcohol-related violent deaths than other metros in the country, according to the latest National Injury Mortality Surveillance System report. Drunkenness was responsible for 59 percent of violent deaths in the city, compared to 47 percent of violent deaths in Durban and Johannesburg, and 51 percent in Pretoria.

Cape Town also has the dubious distinction of being the city with the highest number of alcohol-related road deaths. A staggering 59 percent of road accidents were due to alcohol, compared to 47 percent of road deaths in both Durban and Pretoria.

According to the report, alcohol use is also strongly associated with risky sexual risk behaviour. The outcomes of studies conducted on HIV prevalence, substance abuse and associated high-risk practices over the past eight years, all echo the same concerns: the need for interventions to address the growing substance abuse problem and its links to risky sexual behaviour.

The report says there are not enough treatment centres for women, blacks, rural dwellers and poor people.

"With increasing pressure to treat young methamphetamine-using clients, it is highly likely that access to treatment for older alcohol-dependent persons has become increasingly difficult in the Western Cape," the reports says.

The Demographic and Health Survey reported that binge drinking at weekends was higher among women than men, but 25 percent of men and 6 percent of women in the Western Cape consumed alcohol in a "hazardous or harmful manner".

The Western Cape has one of the highest rates of foetal alcohol syndrome in the world.

source: Saturday Argus

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Alcohol Abuse Can Damage Bones

Alcohol disrupts genes needed to maintain healthy bones, which can lead to a decrease in bone mass and bone strength, a new study says.

In previous research, the study authors, from Loyola University Stritch School of Medicine in Chicago, showed that giving rats large amounts of alcohol caused significant decreases in bone density and bone strength, but the mechanisms responsible for these effects weren't clear.

In this new study, rats were injected with an amount of alcohol equivalent to binge drinking for three days or chronic alcohol abuse for four weeks in humans. When they examined genes responsible for bone health, the researchers found that alcohol affected the amounts of RNA associated with these genes. RNA acts as the template for making proteins, the building blocks of bones and other tissue.

Alcohol increased the amount of RNA associated with some genes and decreased the amount of RNA associated with other genes. These changes in RNA disrupted two molecular pathways -- the Wnt signaling pathway and the Intergrin signaling pathway -- responsible for normal bone metabolism and bone mass maintenance, the researchers said.

The findings, published recently in the journal Alcoholism: Clinical and Experimental Research, could help in the development of new drugs to minimize bone loss in people who abuse alcohol. Such drugs also might help people at risk for osteoporosis.

"Of course, the best way to prevent alcohol-induced bone loss is to not drink or to drink moderately. But when prevention doesn't work, we need other strategies to limit the damage," study co-author and bone biologist John Callaci, as assistant professor in the department of orthopedic surgery and rehabilitation, said in a Loyola news release.
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source: Health Day News

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Nurse-led alcohol service praised for cutting costs through better care

An alcohol specialist nurse service has been praised by the government's financial watchdog for making significant cost savings through improvements in care.

The Royal Liverpool and Broadgreen and University Hospitals Trust's specialist nurse service was singled out by the National Audit Office in a report calling for improvements to alcohol services.

Under the Liverpool initiative, patients identified by either a nurse or doctor as having an alcohol-related problem are referred to the ASN service.

They are then screened with a special questionnaire and given advice where appropriate.

The alcohol specialist nurse can also liaise with other medical staff, prescribe medication for acute alcohol withdrawal and develop follow-up pathways so patients can be managed in primary care.

Originally set up in 2004, the service has expanded to include four nurses, one funded by the hospital, with the others funded by Liverpool PCT.

The ASN service has reduced average alcohol consumption in patients treated, reduced re-admission and saved £175,000 in a 20-month period through earlier discharges.

Lynn Owens, nurse consultant at the PCT and one of the nurses who runs the service, said similar clinics could help other hospitals save money and improve patient care.

She told NT: 'It reduces the necessity to stay in hospital when patients come in with other co-morbidities and conditions. We are also better able to treat them in their own homes.

'There is no waiting list, [patients] get treatment when they need it, with dignity and compassion,' she added.

The NAO's report, Reducing Alcohol Harm: Health Services in England, surveyed all PCTs in the country and found that one-quarter had not fully assessed alcohol problems in their areas. It also found that 42% had no alcohol strategy and 31% could not provide details of expenditure on alcohol services.

'There is scope to secure better value for money from PCT expenditure on alcohol services, which is not usually based on a clear picture of need,' the report concluded.
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source: Nursing Times

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Drinking goes back and forth

There’s a common misconception about alcoholism that an alcoholic is one who can’t stop drinking once he or she starts.

This is false.

Alcoholics can stop drinking; they do it all the time. Alcoholics are people whose illness creates a mental environment that justifies starting again. The starting and stopping makes the drinker believe he can stop at will.

A guy we’ll call Don showed up recently to talk about his anger and anxiety. There was no question that Don was anxious, but did he have an anxiety disorder? They are two very different things.

His position was that he only had a drinking “issue” when he had too much stress or when unfortunate circumstances conspired to cause him emotional pain. He maintained that when the stress subsided, his drinking decreased and so, it became a non-issue. He was, incidentally, referred for smelling like alcohol at work and as it turned out, had been warned several times before.

What Don and his anger management and anxiety counselor didn’t adequately understand was that Don’s drinking had helped to create the very circumstances he became angry and anxious about and that he categorized as “stress.”

Periodically, Don couldn’t keep up with his body’s demand for more alcohol and would quit, cold-turkey, albeit not without several days of shaky hands, sleepless nights and sweaty palms.

Usually, within a week of “quitting,” Don’s disease convinced him he was healthy enough to “handle it this time,” and the cycle would continue. The only change was that the drinking increased and the consequences became more severe.

Don’s story is considerably more common than many of us are aware. Thanks to Don’s employer, he’ll start getting the help that he needs and maybe this time it really can be different.
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source: Illinois Northwest Herald

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Ex-gambler: The need to win fuels addiction

Robert P. is banned from entering Paradise Casinos. If he is caught, he will be kicked out. But he doesn't plan to return because he was the one who banned himself from the casino in the first place.

Robert P. a compulsive gambler in recovery from Yuma who insisted on anonymity, said he thought enough was enough and walked into the casino, asked to be escorted to the security guard's office and filled out the self-ban paperwork. The last time he gambled was in 2004.

"At one time I was $50,000 in credit card debt, making minimum payments and barely keeping my head above water," Robert P. said. "My head was so screwed up I thought I had it under control."

Now, he helps run Gamblers Anonymous in Yuma. The group usually has about 10 members. When winter rolls around, the group has up to 20 members.

"We like to joke that we are the only people that have a gambling addiction, but there are a lot of people that have gambling addictions in this town and they're like the functioning alcoholics. The guy that goes to work everyday and holds a steady job and takes care of his family and everything but he's an alcoholic," Robert P. said.

Gamblers Anonymous is based on the attraction rather than promotion, he said. They provide a place where somebody who wants to quit gambling can come to find help. "The biggest problem is that you really, really, really, want to," Robert P. said.

In Arizona, a total of 690 specific calls were made to the Arizona Department of Gaming Office of Problem Gambling during the fiscal year from July 2007 through June 2008. Thirty-eight of them were callers from Yuma County, according to Arizona Helpline Statistics.

Peter Mangan, senior lecturer in psychology that specializes in neuro-cognitive development at Northern Arizona University-Yuma, said that there is strong evidence that indicates that gambling addiction should be treated just as if it were a drug addiction.

"The drug user uses it to relieve tension or to increase emotions and what gamblers do is they expect the potential reward that keeps them gambling," Mangan said. "One of the things that is found is when they win, the levels of a neuro-transmitter called dopamine, increases dramatically and dopamine is the principal transmitter that activates these pleasure centers of the brain.

"Anytime you go way above what is the norm, the opponent process goes through and then you go into depression. So now people have to gamble in order to escape depression," he said. "So it's not just that they want to win, they need to win to overcome the depression that falls after the euphoria wears off. But there are numerous different kinds of factors and reinforcement such as simple classical Pavlovian conditioning that adds to the gambling addiction."

Robert P. said it's getting easier for people to gamble but it's not the prevalence of gambling establishments but the person. "When I first started the GA program, I said to myself if the casinos weren't there I wouldn't have a problem...well if they weren't there I'd still have a problem and just find a way to do it any other way," he said.

Between the Arizona Tribal/State compacts, the Arizona Department of Gaming established a self-exclusion (self ban) procedure. It allows an individual to ban himself/herself from all casinos in Arizona for a specified period of time.

Liz Pratt, communications director for the Cocopah Indian Tribe, said the Cocopah Casino offers the self-exclusion program and a helpline is posted at every entrance in the casino.

"If a person volunteers to be admitted to the self-exclusion program, the casino will abide by the person's wishes and will do everything that they can to make sure that they keep to their promise of their self-exclusion," Pratt said.

Barrett DeFay, marketing director for Paradise Casino, said the casinos also have self-ban documentation available at Paradise Casino for those who believe they need to seek help.

"The casino and tribe are happy to contribute money through the state of Arizona gaming compact every year and we proudly support Arizona Next Step (helpline) ," DeFay said. " We believe all people should gamble responsibly and practice responsible gaming."

Usually seeking help is the most difficult step a person can do, says Robert P., but over time every person has a potential to build a tough exterior from relapsing.

"It's a way of life and the most successful people in the program have discussed that the only way to stay in the program is if they treat gambling like any other addiction," he said.

For more information on how to seek help if you are a gambling addict or know someone who has a gambling addiction please call the Arizona helpline at 1-800 NEXT STEP or visit www.problemgambling.az.gov.


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Stephanie Sanchez can be reached at ssanchez@yumasun.com or 539-6847.

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THE FOUR PHASES OF ESCAPE GAMBLING
Intro phase characteristics:
• Several small or even large monetary winning episodes. Although money is usually secondary for escape gamblers, they may see gambling as a way to solve financial difficulties, become financially independent or make extra money.
• Emotional escape from life's problems may be experienced while in the act of gambling.
• Excitement and living on the edge is another feeling that may be present.
Losing /chasing characteristics:
• Losses are rationalized as bad luck with the "big win" right around the corner
• The cycle of wining, losing and breaking even begins
• No win is "enough"
• Wagers increase
• Hides gambling activities
• Lies to cover money spent
• Unsuccessfully attempts to limit or stop gambling
• Gambles until last dollar is gone
• Sells items to finance gambling
• Feels remorse after gambling
• Angry when confronted about gambling
• Receives bailout
Desperation Phase:
• Obsessed with gambling
• Neglects physical well-being
• Loses reputation
• Loses Friends and/or family
• Commits illegal acts related to gambling including embezzlement, theft, bad checks, insurance or credit card fraud
• Relapses into previous addiction(s)
• Loses car
• Has frequent thoughts of suicide
Hopeless Phase:
• Risks possible incarceration
• Approaches emotional breakdown
• Faces financial ruin
• Attempts suicide
Source: Adapted from "Four Phases of Escape Gambling," Arizona Council on Compulsive Gambling

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Take The First Step: Opiate blockers can help addicts stop using

Take The First Step
Dr. Michael Levy

Q: I have been hearing that parents of opioid-addicted children want more information about naltrexone. Do you have any experience with this treatment? Does it work? Thanks.

A: There are two ways that naltrexone-type medication is being used for the treatment of opiate addiction. I say naltrexone-type medication because in general, naltrexone is an oral form of the medication naloxone, and naloxone is also used, which can be injected or inhaled. One use of this drug is to increase abstinence rates and enhance treatment outcome, and the other is to counter an opiate overdose.

First, naltrexone is a pure opiate antagonist, which means that it blocks the effects of opiates because it binds on the same receptor sites that opiates bind to in the brain. If a person has ingested naltrexone and uses opiates, the person will not feel the effect of the opiate.

Naltrexone has been around for many years, and while it is effective, its use has been fairly low for a number of reasons. One big reason for this is that many individuals who struggle with opiates are ambivalent about taking this drug because they clearly will not be able to get high on opiates if they have naltrexone in their system. As often there is ambivalence about changing, compliance with taking this drug has been low.

However, if a person is very motivated, treatment outcome can be very good. As I always say, ongoing psychosocial therapy in conjunction with taking this medication is also important. There are also naltrexone implants that can be used, which increases compliance as the naltrexone in the implant lasts for an extended period of time and there is no need to remember to take it daily. Finally, an injectable form of naltrexone, called Vivitrol, can also be used, which lasts for one month. However, Vivitrol is not FDA-approved for the treatment of opiate addiction, but some physicians have been using this off-label for that purpose.

Narcan, or naloxone, is also used to treat opiate overdoses and saves lives. If a person who has overdosed on opiates is given this drug, it rapidly will counter the effects of opiates and reverse the overdose. This drug is given at emergency rooms and by emergency medical technicians (EMTs).

There are also several pilot programs in Massachusetts that give a nasal form of Narcan to opiate addicts, as well as friends and relatives of opiate addicts. These individuals are trained how to use Narcan in the event that someone has overdosed on opiates. This obviously allows the opiate overdose to be treated quickly, even before EMTs arrive, and helps to save the person's life. CAB is one of the pilot programs and a person can call 781-592-4477 to find out more about this.

So in answer to your question, different forms of naltrexone are being used for the treatment of opiate addiction, both to help individuals recover from opiate addiction, and to treat, on an emergency basis, opiate overdoses. This medication can be helpful to opiate addicts who are motivated to stop using opiates, and on an emergency basis, it can clearly save someone's life.
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source: http://www.gloucestertimes.com

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Professor researches young adult alcohol dependency

Johnson’s study to evaluate effectiveness of anti-nausea medication in reducing alcohol craving, binge-drinking tendencies in 300 young adults ages 18 to 25

University researchers are preparing to launch a study that has the potential to influence the way alcohol dependence in young adults is treated.

Bankole Johnson, chair of the department of psychiatry and neurobehavioral sciences, will lead a clinical test of the effectiveness of ondansetron, traditionally used as an anti-nausea medication, in treating alcohol abuse in adults ages 18 to 25.

“Ondansetron ... contains a chemical that reduces [the] craving for alcohol and binge drinking,” Johnson said.

The clinical study will involve eight weeks of treatment with the drug, Johnson said, including two sessions of psychosocial intervention and follow-up monitoring. Three hundred people who are currently binge drinking will take part in the study, he said, most likely including a number of University students.

The study — which will take about four years to complete, according to Johnson — is being funded by a $3.2-million grant from the National Institute on Alcohol Abuse and Alcoholism. Raye Litten, associate director of the division of treatment and recovery research at NIAAA, said the institute is particularly interested in Johnson’s study because of the young age of the population Johnson will be testing.

Litten said the average age of people who participate in NIAAA clinical trials is about 40, despite the fact that the average age of the onset of alcohol dependence is 20 to 21. According to Litten, high risk drinking behavior — which he defines as drinking more then five drinks in one night for men and drinking more then three drinks for women — can lead to longer term effects in this younger age group including dependency.

“If he finds this [drug] is effective, you could treat people as they develop [dependence] at an earlier age, rather than let it progress,” Litten said, adding that currently, most people take at least eight years to seek treatment for alcohol abuse.

“This could prevent long-term effects much better than letting [abuse] go on for years and years,” he said.

An earlier study conducted by Johnson concluded that ondansetron is not very effective in treating later-onset alcohol abuse, Litten said, but also found the drug is more effective for cases of early onset alcohol abuse, making it an “ideal drug to test on this population.”

The study also will focus on the effect of genetics on treatment response, Johnson said.

“If a person has a certain genetic profile, he or she may respond better to the drug ... and have fewer side effects,” Litten said, expanding upon the genetic aspect of the study. “It would be nice, before you give someone a drug, to know if they have a chance to respond to it.”

If his hypothesis is confirmed, Johnson said doctors could be able to offer medication targeted toward binge-drinking students for the first time.

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All aboard the 'Ocsober' no-booze bus

During the month of October, many people push their livers to breaking point as every pub, club and restaurant runs its interpretation of the Bavarian beer festival, Oktoberfest.

But one organisation is hoping to buck the trend and encourage alcohol abstinence for a good cause.

Called Ocsober, the fundraising initiative by non-profit organisation Life Education urges Australians to embrace sobriety for one month to raise money for drug and alcohol awareness among school students.

Statistics collated by the Drug Info Clearinghouse revealed one third of Australian teenagers engage in binge drinking, with those who start before the age of 15 becoming five times more likely to become alcohol-dependent than those who don't start until they are 21.

During Ocsober, a fleet of mobile Life Education centers will visit more than 120,000 school students to raise awareness of the dangers of binge-drinking.

Brisbane students at Middle Park Primary School will tomorrow release personal messages attached to balloons, as part of a sobering reminder for adults to halt alcohol abuse this month.

"When you read what the children have written, it moves you to tears," Ocsober Project Manager Michael Fawsitt said.

"How can any of us tell a 12-year-old that we can't stop drinking alcohol for one month for such an important cause?

"Ocsober is about the future health and well-being of our children and it's up to adults to set an example and give children the best opportunity to grow up safe and healthy."

The Australian Family Association has supported the fundraising gimmick, as has the Community Alcohol Action Network.

Australian Family Association spokesman John Morrissey said the use and abuse of alcohol was deeply rooted in Australian culture.

"For young people, drinking is ingrained as a rite of passage," Mr Morrissey said.

"Yet, for all of this, drinking is celebrated as if it were quintessentially Australian."

He said the responsibility fell upon adults to lead by example.

Those adults keen to support the cause, but unable to resist the occasional cold one have been accounted for since participants are allowed to buy "leave passes".

"If you have a special event during October and you need a break from your Ocsober campaign, there's an easy option so you don't break your commitment to a whole month without alcohol," the guidelines read.

"Simply buy a one day or two day Leave Pass and then complete your Ocsober month as planned."

Families, friends and colleagues are encouraged to band together and remain grog-free for 30 days, beginning in October.

Life Education CEO Jay Bucik said rather than being a "wowser" event, Ocsober was more about encouraging adults "get real" about their alcohol intake.
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source: Brisbane Times

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More congregations create addiction ministries

125 Unitarian Universalist congregations now offer ministries to people struggling with addiction.

The cover story of the summer 2004 issue of UU World profiled the Rev. Dr. Denis Meacham’s drive to help congregations develop ministries to those who struggle with addictions. When Meacham started his own addictions ministry at First Parish in Brewster, Massachusetts, in 2000, there were no others. Today around 125 congregations have such ministries and a move is underway to gain official recognition and support for addictions ministry from the Unitarian Universalist Association.

In 2004 Meacham wrote The Addiction Ministry Handbook, now considered the bible of UU addictions ministry. One person who bought the book after reading the UU World article is Bill Norton, a member of Shoreline Unitarian Universalist Church in Shoreline, Washington.

“I had an epiphany when I read that article in the World,” said Norton. “My own addiction and recovery experience and the possibility of ministry for addictions came together. I stood up in the middle of church and waved Denis’s book and said ‘I’m interested in doing this. Come see me if you are too.’” People did, and now Shoreline has a thriving addictions ministry. Norton is the program’s co-facilitator.

Shoreline’s addictions ministry includes Chalice Circle, a covenant group focused on addictions. The ministry also provides workshops and an occasional worship service, and has trained people as “first responders” to react to immediate needs. “Now anyone in pain knows where to come,” said Norton. “We don’t fix the problems, but we’re a source of information and support.”

Julie Hernandez is a coordinator of the Addictions and Recovery Ministry at Pacific Unitarian Church in Rancho Palos Verdes, California. The UU World article also sparked a conversation among members of her church. They bought the handbook, started a committee and within a few months an addictions ministry was formed. “We launched it and people came to our events and now we have a vibrant program,” said Hernandez.

The addictions team brings speakers to the church and organizes seminars on addiction-related topics. The team is visible every Sunday with an information table. Articles on addiction appear regularly in the church newsletter, and the ministry has trained a team of first responders. A “Twelve-Step, Seven-Principles” group has evolved into a covenant group. Said Hernandez, the group “provides people who are on a spiritual search, as they try to overcome addictions, with an opportunity to explore a twelve-step program that uses the lens of the UU Principles.”

“There are a lot of people who are troubled by the Christian and male-oriented language of the Alcoholics Anonymous meetings,” added Hernan­dez, who turned away from alcohol five years ago. “That’s why I came to Pacific Unitarian after entering recovery. After I read the Seven Principles, I knew for sure no one there would tell me what I should be thinking. Unitarian Universalism is in a wonderful position to help people like me.”

The program is working on a variety of levels, said Hernandez. “There are lots of people now that we can call on for help. The interest in events is very much on the rise and the feedback just gets better and better.” She said events attract from fifteen to fifty people. Ministerial support is also important, she noted. “A very large part of our ministry’s growth and vitality is due to the Rev. (John) Morehouse’s unflagging support and enthusiasm.”

The Rev. Alex Holt, who recently moved from the Woodinville, Washington, Unitarian Universalist Church to become consulting minister in Yakima, Washington, has become the facilitator of a UUA task force on addictions ministry. It is working toward official UUA recognition and support of addictions ministry. The Rev. Jory Agate, the UUA’s ministerial development director and a member of the task force, notes that ministers, as well as lay people, struggle with addictions. She anticipates that a UUA addictions ministry would be developed through the collaboration of many UUA staff groups, including Ministry and Pro­fessional Leadership, Congregational Services, and the youth and young adult offices. “We all need to work together on this issue,” she said. When Holt, a recovering alcoholic, visits a church that’s thinking about an addictions ministry, he’ll ask at a Sunday service, “How many of you, over your lives, have been affected directly or indirectly by addiction, including behaviors and substances?” Nearly everyone responds.

Holt notes that most of the people in a congregation who will respond to an addictions ministry will be family and friends of people with addictions. “People who have a family member in crisis want to know what they can do.” The primary addictions are alcohol, drugs, sex, food, and gambling, he said.

When Holt is invited by a congregation, he generally leads a Sunday service and follows it with a three-hour workshop in the afternoon. “We find people have an incredible craving to share their stories,” he said. “Out of that we help them develop the basics of an addictions ministry program that is safe, open-minded, and supportive, but not therapy. We try to give people resources and community without judging them.”

The UUA’s Pacific Northwest District, where Holt’s congregation is located, has one of the first district-wide addiction ministries. Eleven PNWD congregations have such ministries.

At Saltwater Unitarian Universalist Church in Des Moines, Washington, a worship service about members’ experiences in 12-step groups led to the formation of an addictions ministry there, said Kristen Parman-Bethard, addictions ministry team chair. The ministry includes a lending library with information about a wide range of substance and behavioral addictions. There are alternative Alcoholics Anonymous and Al Anon (for family and friends) groups that allow people to define “Spirit of Life” for themselves. The team held a class on prescription medications and has sponsored two “Recovery Sunday” services. “They weren’t terribly well attended,” said Parman-Bethard, “however, I believe the people who needed to be there were there. Several people contacted members of our team to say how much the service touched them.”

“Our church has been helped by making this a topic that is more open for discussion,” said Parman-Bethard. “Many people have concerns about family members or other loved ones and now they have safe people to talk to. Some have concerns about themselves and they also know we are here. I would say we don’t have a dynamic presence, but rather a ‘ministry of presence’ that is always visible and supportive.”
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source: http://www.uuworld.org

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The drinking party is over for this Aussie mum

Aged just 21 and in rehab without her baby boy, Dannielle Adamo is the public face of a binge-drinking culture that has spun out of control.

Every Saturday she would drink a carton of Vodka cruisers on her own - a staggering 24 x 275ml bottles - and then go to the bottle shop to buy other drinks.

With the State Government now committed to reducing drinking hours in pubs and clubs and targeting underaged drinkers, Ms Adamo has gone public over her rapid slide into alcohol abuse to warn others.

She began binge drinking pre-mixed drinks with friends at weekends as a teen because she wanted to fit in and feel more confident.

The party for Ms Adamo is over, after she decided it was time to hand her son over to her ex partner and check herself into a rehab clinic to treat her alcohol abuse.

Far from the traditional image of an old drunk sleeping rough on the streets, Ms Adamo is part of a new breed of young alcoholic.

Her story comes as a report from the Australian Institute of Health and Welfare showed the number of people seeking treatment for alcohol as the main drug of abuse for a growing number of addicts.

Yesterday, Ms Adamo supported Police Commissioner Andrew Scipione's push for licensed premises to close at 2am to address Sydney's binge-drinking culture.

"I think it's a good idea," Ms Adamo said.

It was not until Ms Adamo faced her second drink-driving charge last month that she decided to check herself in to rehabilitation centre Selah at Berkeley Vale on the Central Coast.

After crashing into a power pole on September 14, she decided to hand herself in to police.

Handing over her 14-month-old son Jayden to her ex-partner while she underwent a 10-month program was the most difficult thing she has ever had to do.

"It's good that I did it now before anything worse happened, I never drove drunk while he was in the car," she said

Last weekend she was refused bail in court and was jailed.

"That made me open my eyes a little bit," she said.

Ms Adamo grew up in Morrisett near Newcastle and worked in a juice bar before having Jayden.

She said she would begin drinking about 4pm on Saturday with a pack of pre-mixed vodkas.

"Now I'm finding out a lot about myself that I never knew and why I used to drink, how I can stop and how I can live a life without alcohol," she said.
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source: Daily Telegraph

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The Facts About Hydrocodone Addiction

Hydrocodone addiction is a growing crisis in the United States. While illegal drugs like cocaine, marijuana, methamphetamine, and heroin remain in the headlines many individuals may be surprised to know that hydrocodone addiction could lurk right behind them as one of the most widely-abused drugs of addiction. In fact, the federal Drug Enforcement Administration believes hydrocodone may be the most abused prescription drug in the country. Nationwide, its use has quadrupled in the last ten years, while emergency room visits attributed to hydrocodone abuse soared 500 percent.

Hydrocodone is a narcotic that can produce a calm, euphoric state similar to heroin or morphine--and despite such important and obvious benefits in pain relief, evidence is pointing to chronic addiction. Pure hydrocodone is a Schedule II substance, closely controlled with restricted use. But very few prescription drugs are pure hydrocodone. Instead, small amounts of hydrocodone are mixed with other non-narcotic ingredients to create medicines like Vicodin and Lortab. This means they can be classified under Schedule III with fewer restrictions on their use and distribution.

Vicodin, Lortab--and more than 200 other products that contain hydrocodone--are regulated by state and federal law. But they are not controlled as closely as other powerful painkillers. The lack of regulation makes them vulnerable to widespread abuse and addiction through forged prescriptions, theft, over-prescription, and "doctor shopping." Hydrocodone pills have been sold for $2 to $10 per tablet and $20 to $40 per 8 oz bottle on the street.

Subject to individual tolerance, many medical experts believe dependence or addiction can occur within one to four weeks at higher doses of Hydrocodone. Published reports of high profile movie stars, TV personalities and professional athletes who are recovering from Hydrocodone addiction are grim testimony to its debilitating effects.

Hydrocodone is structurally related to codeine and is approximately equal in strength to morphine in producing opiate-like effects. The first report that hydrocodone produced a noticeable euphoria and symptoms of addiction was published in 1923; the first report of hydrocodone addiction in the U.S. was published in 1961.

Every age group has been affected by the relative ease of hydrocodone availability and the perceived safety of these products by professionals. Sometimes seen as a "white-collar" addiction, hydrocodone abuse has increased among all ethnic and economic groups. DAWN data demographics suggest that the most likely hydrocodone abuser is a 20-40 yr old, white, female, who uses the drug because she is dependent or trying to commit suicide. However, hydrocodone-related deaths have been reported from every age grouping.

Examples of how severe Hydrocodone addiction has become:

An estimated 7 million dosage units were diverted in 1994 and over 11 million in 1997.
In 1998 there were over 56 million new prescriptions written for hydrocodone products and by 2000 there were over 89 million.
From 1990 the average consumption nationwide has increased by 300%. In the same period there has been a 500% increase in the number of Emergency Department visits attributed to hydrocodone abuse with 19,221 visits estimated in 2000.
In 1997, there were over 1.3 million hydrocodone tablets seized and analyzed by the DEA laboratory system.
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source: drug-addiction.com

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The more the booze, the tinier the brain

The more you drink alcohol, the smaller your total brain volume gets, according to a new study by Wellesley College, Massachusetts.

The study found that even moderate alcohol consumption can lead to decline in brain volumes.

Lower brain volumes have been linked to progression of dementia and problems with thinking, learning and memory.

In the study involving 1,839 adults, the participants underwent magnetic resonance imaging (MRI) and a health examination.

"Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers," the authors write.

"There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume," they added.

The research team led by Carol Ann Paul, MS, of Wellesley College also found that although men were more likely to drink alcohol, the association between drinking and brain volume was stronger in women.

This could be due to biological factors, including women's smaller size and greater susceptibility to alcohol's effects.

"The public health effect of this study gives a clear message about the possible dangers of drinking alcohol," the authors write.

"Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption.

"This study suggests that, unlike the associations with cardiovascular disease, alcohol consumption does not have any protective effect on brain volume," they added.

The report appears in the October issue of Archives of Neurology, one of the JAMA/Archives journals.
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source: http://timesofindia.indiatimes.com

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Methamphetamine enters brain quickly and lingers

Using positron emission tomography (PET) to track tracer doses of methamphetamine in humans' brains, scientists at the U.S. Department of Energy's (DOE) Brookhaven National Laboratory find that the addictive and long-lasting effects of this increasingly prevalent drug can be explained in part by its pharmacokinetics - the rate at which it enters and clears the brain, and its distribution.

This study in 19 healthy, non-drug-abusing volunteers includes a comparison with cocaine and also looked for differences by race. It will appear in the November 1, 2008, issue of Neuroimage.

"Methamphetamine is one of the most addictive and neurotoxic drugs of abuse," said Brookhaven chemist Joanna Fowler, lead author on the study. "It produces large increases in dopamine, a brain chemical associated with feelings of pleasure and reward - both by increasing dopamine's release from nerve cells and by blocking its reuptake."

Studies by Fowler and others have shown that drugs that produce greater elevations in brain dopamine tend to be more addictive. But other factors, including the speed with which a drug enters and clears the brain and its distribution within the brain, can also be important in determining its addictive and toxic potential.

In undertaking this first study of methamphetamine pharmacokinetics, the researchers also wanted to know if there were differences between Caucasians and African Americans. "Reports that the rate of methamphetamine abuse among African Americans is lower than for Caucasians led us to question whether biological or pharmacokinetic differences might explain this difference," Fowler said.

The scientists measured brain uptake, distribution, and clearance of methamphetamine by injecting 19 normal healthy men (9 Caucasian, 10 African American) with a radioactively tagged form of the drug in "trace" doses too small to have any psychoactive effects. They used PET scanning cameras to monitor the concentration and distribution of the tagged methamphetamine in the subjects' brains. On the same day, the same subjects were injected with trace doses of cocaine and scanned for comparison. The scientists also used PET to measure the number of dopamine reuptake proteins, known as dopamine transporters, available in each research subject's brain.

Like cocaine, methamphetamine entered the brain quickly, a finding consistent with both drugs' highly reinforcing effects. Methamphetamine, however, lingered in the brain significantly longer than cocaine, which cleared quickly. In fact, some brain regions, particularly white matter, still showed signs of tracer methamphetamine at the end of the 90-minute scanning session, by which time all cocaine had been cleared. The distribution of methamphetamine in the brain was remarkably different from that of cocaine. Whereas cocaine was concentrated only in the 'reward' center and cleared rapidly, methamphetamine was concentrated all over the brain, where it remained throughout the study.

"This slow clearance of methamphetamine from such widespread brain regions may help explain why the drug has such long-lasting behavioral and neurotoxic effects," Fowler said. Methamphetamine is known to produce lasting damage not only to dopamine cells but also to other brain regions, including white matter, that are not part of the dopamine network.

Surprisingly, the researchers found significant differences in cocaine pharmacokinetics between African Americans and Caucasians, with the African Americans exhibiting higher uptake of cocaine, a later rise to peak levels, and slower clearance. In contrast, the scientists found no differences in methamphetamine pharmacokinetics between these groups.

"This suggests that variables other than pharmacokinetics and bioavailability account for the lower prevalence of methamphetamine abuse in African Americans," Fowler said. "The differences observed for cocaine pharmacokinetics are surprising considering there are no differences in cocaine abuse prevalence between these two ethnic groups." These differences may merit further study, and also suggest the need to match subjects by ethnic group in future studies to avoid interference from this potentially confounding variable.

Another interesting finding was that across all research subjects, the level of dopamine transporters was directly related to the level of methamphetamine taken up by the brain. This finding suggests that transporter proteins somehow play a role in regulating the brain's uptake of this drug.

This research was funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism Intramural Program, and by the Office of Biological and Environmental Research within DOE's Office of Science. Brain-imaging studies such as PET are a direct outgrowth of DOE's long-standing investment in basic research in chemistry, physics, and nuclear medicine. The ongoing neuroimaging research at Brookhaven is a prime example of how DOE's national laboratories bring together the expertise of chemists, physicists, and medical scientists to address questions of profound significance for society.
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http://www.bnl.gov/

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Tradition Ten and Controversy

It was the first Monday of the month and that meant reading and discussing a tradition. Those of us “regulars” at the K.I.S.S. (Keep It Simple Sisters) meeting usually expect fewer women on a Tradition Monday but this night, the room was amazingly full. We were reading Tradition Ten from the “Twelve Steps and Twelve Traditions” and unlike shares for many of the traditions, this one was lively and very animated.

Tradition Ten states that “Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.” What immediately comes to mind is that we are getting close to election time and this particular election is evoking a lot of emotions in a lot of people. Think about what would happen in your fellowship if someone, during his or her share, endorsed a candidate. Think what would happen if you went to a meeting and there were political posters all over the meeting room and the candidate was not of your choosing. I’m sure it is not going to make you go out and have a drink (or drug, eat, gamble, not eat, shop, etc.) but if you are like me, you might be annoyed just enough to make a decision to stay away. If you are a newcomer, I am positively sure you would get the wrong idea about the fellowship and that might be your first step back into your addiction.

It isn’t just politics that should be left out of the fellowship. There are times when a person shares, he or she gets on the soapbox and promotes a belief or idea that perhaps isn’t terribly controversial but makes people very uncomfortable. And why would we feel uncomfortable? Because someone else is going to respond in a negative way to what was said and what have we got here, folks? We’ve got ourselves a real, live fellowship argument? People take sides; sometimes silently, sometimes not. It is never a positive experience.

Some people, not just those of us in recovery, have very short fuses. This doesn’t necessarily change because someone has been in recovery for any length of time. My own experience is that the longer someone has been in recovery it seems the more they feel entitled to state their opinions as truth for everyone or does not hesitate to be the first to respond to another if he/she disagrees. This is my experience. It may not be yours. I’ve come to the conclusion that people who are inappropriate in their sharing might still have a need to control or maybe they are a bit too righteous. Whoops! Am I taking their inventory? I am not intending to do that. Honestly, I think they are just human beings and that’s just how they are. Recovery doesn’t change our humanness. If that were the case everyone would want to be a part of a 12 Step group just to be perfect.

Personally, I have always hated controversy. I hate it even more when it happens in a meeting. I don’t think I’m the only one. Group conscious meetings are historically known to create some tensions because, it seems, that personal opinions run higher than normal. And we wonder why no one wants to stick around and be a part of one. One of the women at the meeting said that she believes that if what you say publicly (in a meeting) is based on “your experience” it is a much safer bet then to be making others believe your way is the only way. This is particularly important because AA and other programs have no rules; no best way for everyone. The steps are but suggestions.

A number of years ago (pre-recovery), I was in a leadership position at my job. My boss and I had one agreement. We would agree to disagree. And we never agreed on anything. It was the best and most productive position in my career. Why? Because we set ground rules and nothing was ever personal. It’s a bit different when you are in a recovery program because the only agreements we have are, in fact, the traditions and that doesn’t mean everyone reads them the same way. The Traditions, however, are our boundaries. The reason why AA is still around today is because there were and still are enough people who hold onto the original traditions to keep it in tact. 12 Step programs should be safe. Our purpose is to stay sober and to help other alcoholics. How can we possibly help another addict when they are too frightened or disgusted to come back to a meeting?

The most important message I can give or share (as I see it) is that each one of us has to make a conscious effort to be mindful of what we say and how we say it. I don’t think that means we have to be afraid to share but I do think we have to have the common sense to know if we are going to create a controversy. Likewise, maybe you are the person who wants to respond to a person creating the controversy. It takes two people to begin any type of argument or confrontation. Personally, I prefer to be neither.

Lastly, we are human and rather complicated but we have to keep in mind that our own sobriety and recovery is the most important thing in our lives. Before you decide not to attend a meeting because you were uncomfortable or angry, remember who you are punishing. If you are even at the very beginning of working a 12 Step program, you already realize that you have choices. Don’t let anyone else make them for you. We each have a responsibility to ourselves to be happy, joyous and free. It is our destiny.

Namaste’. May you walk your journey in peace and harmony.
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source: http://www.bellaonline.com

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Am I drinking too much?

How do you know when your drinking is out of control? Take our simple questionnaire, compiled by doctors from the Royal College of Psychiatrists, to find out

Many people drink alcohol for enjoyment, so it can be hard to know when regular use of alcohol has developed into a serious problem. Many of the problems associated with alcohol misuse are caused by having too much to drink at the wrong place or the wrong time If you think you may be drinking too much answer the following questions.

1. Do you ever worry that you drink too much?

2. Have friends or family expressed concern about you about your drinking habits?

3. Do you find you can drink a lot without becoming drunk?

4. Do you need to drink more to have the same effect?

5. Have you tried to stop drinking, but found that you were unable to for more than a few days?

6. Do you carry on drinking even though it is interfering with your work, family or relationships?

7. Do you need a drink to start the day?

8. Do you get shaky, sweaty or anxious a few hours after your last drink?

9. Have you experienced blanks in your memory, where you can’t remember what happened for a period of hours or days?

10. Is your judgement affected by alcohol, so that you do things that you normally wouldn’t, such as starting fights or arguments, having unprotected sex with strangers or becoming violent.

If you answer yes to more than three of these questions, it is indicator of alcohol misuse.

Questionnaire compiled by Dr Jim Bolton and Dr Martin Briscoe, consultant psychiatrists and members of the Royal College of Psychiatrists Public Education Editorial Board
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source: The Times

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Officials fight binge drinking through 'That Guy' campaign

9/22/2008 - WASHINGTON (AFPN) -- Now in its third year, a campaign managed by officials with the Military Health Systems and the Tricare military health plan continues the effort of Defense Department leaders to reduce excessive and binge drinking among 18 to 24 year olds serving in the armed forces.

The "That Guy" campaign has two goals: to reduce alcohol abuse and to raise awareness of the negative short-term social consequences of excessive drinking.

It was developed in response to findings of the DOD's survey of health-related behaviors, said Chuck Watkins, the "That Guy" campaign program manager. The "That Guy" campaign tells cautionary tales of excessive drinking and its consequences in a way to which young servicemembers can relate.

Mr. Watkins, who has been involved for the past three years on the harm-reduction campaign, said its style is unlike that of other health-promotion campaigns.

Its use of edgy humor and peer-to-peer mentoring captures the essence of who "That Guy" is and ways to prevent abusing alcohol and becoming the subject of ridicule, he said.

"Most recently, the survey detected there has been an uptick in binge drinking among junior enlisted of about 2 percent, and now about 56 percent of junior enlisted said they have engaged in binge drinking at least once in the past month," Mr. Watkins said.
"'That Guy' is anyone who, after drinking an excessive amount of alcohol, loses their self control," he said. "This frequently has humiliating or embarrassing results, and some of us may be older (than) 18 to 24 and have been 'That Guy' perhaps in our distant past."

DOD surveys have found that while men are more likely to engage in binge drinking, it can apply to anyone who, because of excessive drinking, "behaves in a manner where your friends just don't want to be around you or copy you," Mr. Watkins said.

Early data shows that attitudes are changing, he noted.

"That early data does indicate that attitudes ... toward excessive drinking have begun to shift in a positive direction," Mr. Watkins said.

Offering support, particularly for servicemembers who recently have returned from combat, is part of educating them on the negative health consequences of excessive drinking, he said.

"Deployment is definitely a risk factor for disorders such as anxiety and binge drinking, and each of the four armed services have several programs that address these programs both through prevention and treatment," he said.

Small and large military installations around the world actively participate in the "That Guy" program.

"We have nearly 150 installations that are involved that range from the giant installations to the smallest," Mr. Watkins said.

The campaign is based on social marketing research concerning changing behaviors, Watkins emphasized, and is not an abstinence campaign. He added that officials want people to think before they take their next drink and to avoid becoming "That Guy."

"The aim is to raise awareness, and ultimately change drinking behavior among the targeted audience," he said. "An example is while most people agree that drinking and driving is unacceptable, maybe they don't feel that same way about getting just totally wasted, as long as they don't harm anyone other than themselves. But what we are trying to do is point that out and promote peer disapproval about out-of-control behavior."
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source: Air Force Link, http://www.af.mil

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Local leaders celebrate expanded halfway house

“A miracle has happened in this part of Southern Indiana.”

Help available for men recovering from drug and alcohol addiction in the area will increase, as Serenity House cut the ribbon on the first phase of its recovery complex Friday afternoon.

The new building, near Interstate 65 and Stansifer Avenue on Homestead Lane, ups the halfway house’s capacity from 24 beds to 48 beds. Local officials and contributors celebrated the expansion during a ribbon-cutting ceremony.

“It’s a wonderful facility,” said Judge Vicki Carmichael, who presides over Clark County Superior Court No. 1. “And Serenity House has always done a great job.”

“The countless lives that will be touched by this facility is just unreal,” said Herb Bass, president of Serenity House’s board.

He noted that when the halfway home opened more than 30 years ago, it served only eight people. But through the years, those who have gone through the program have become productive members of society.

“By doubling capacity, we hope to be having the same type of success that we’ve had,” he said.

Mayor Tom Galligan acknowledged that some people don’t like having such places in the community, but he believes it to be an asset for the city.

“Without them, our community wouldn’t be as good as it is,” he said. “Every time we help somebody, we help our community.”

The 24 residents at its old location, on Sunset Drive, have already moved to the new facility. Bass believes the rest of the beds will fill quickly and that a waiting list will likely develop.

Serenity House requires its residents to hold full-time jobs. They also have to abide by a curfew and rules have to be adhered to in order to continue living there, said Executive Director Mick McFarland.

The complex shows them basic ways to live and how to have fun without drinking and drugs, he said. Most come to the recovery complex through the court system or other treatment programs.

Rent is $71 per week, which includes meals and extras such as laundry detergent. The project has taken at least six years to come to fruition.

Financing has been the largest hurdle, along with problems getting the state to release land it owned in the area.

About $2.5 million was raised for construction. Another wing is being planned, which will serve as a meeting house for those living at the facility and those who have graduated from the program.

Another $1.5 million is needed for that part of the complex.
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source: News and Tribune, http://www.news-tribune.net

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AA hosts convention to celebrate 20 years in Torrevieja

The English-speaking group of Alcoholics Anonymous in Torrevieja celebrated its 20th birthday on September 6.

A number of visitors, primarily from the UK and Ireland, together with other English-speaking AA members from the rest of Spain, joined local members to celebrate this special anniversary.

The group in Torrevieja started in 1988, initially with meetings at an urbanisation on the outskirts of the town, La Siesta. The founding member, then in her early months of sobriety, often sat alone waiting for others to come along, which they eventually did, usually visitors from the UK, Ireland and Scandinavia.

She still lives on the Costa Blanca, although not in Torrevieja, and remains in AA to this day. Her continuing sobriety is just one example of how the programme of AA works for those with a genuine desire to stop drinking and who are willing to work its universal 12-step programme of recovery.

Continuing the traditions of the fellowship founded in the USA in 1935, Alcoholics Anonymous in Torrevieja and on the Costa Blanca has expanded dramatically over the last six years. In the last 20 years, many already sober alcoholics have moved permanently to the area, bringing with them their AA experience of living life without the need to drink, one day at a time, and sharing this with newcomers – that is how AA works. They have been joined by a growing number who have found freedom from their obsession with alcohol for the first time by attending AA meetings and working the famous 12-step programme. Members’ stories, periodically published in The Euro Weekly News, reveal the varying depths to which alcoholics sink before surrendering and seeking help. There is no need for an alcoholic to end their drinking ‘career’ alone, destitute or institutionalised, but it can happen, unless they recognise earlier that they have become, or are clearly becoming, a slave to drink.

In this year alone, local newspapers have reported the deaths of two expats evidently as a result of prolonged alcohol abuse – further evidence of the need for a strong AA presence within the English-speaking community in the area.

Many members first come to AA as a result of persistent pressure from their partners, family or friends. Perhaps this is not the best motive for going to an AA meeting, but, by identifying with all or part of the stories they hear from members, they continue to attend for their own well-being and, by doing so, improve the quality of their home life. By 2001, global membership of AA was, conservatively, estimated at two million people attending meetings organised by 100,800 groups in 150 countries. It is a fully self-supporting organisation, actively declining donations or assistance from outside its own membership.
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source: Euro Weekly News

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Getting over addiction

Addiction to drugs and alcohol is a devastating problem in the U.S., and overcoming it is no easy task.

Now, Central New Yorkers in recovery have another resource to rely on.
Friends of Recovery is an organization founded to provide an outlet and networking opportunities to those recovering from addiction. Formed in 2007, the local affiliate of the national organization states as its mission to “provide social, recreational and educational activities to support people in recovery as well as their families and friends.”

“There are people in recovery in all walks of life,” said Kimberly Sacco, executive director of the Syracuse-Onondaga Drug and Alcohol Abuse Commission, one of the partners in Friends of Recovery. “We want to provide as many resources as we can in the community.”

Friends of Recovery is the result of a collaboration between numerous community organizations, including the Syracuse-Onondaga Drug and Alcohol Abuse Commission, the Prevention Network, Crouse Hospital, Syracuse Teen Challenge, Tully Hill Chemical Dependency Treatment Center, Rescue Mission, Altamont Treatment and the Center for Community Alternatives.

“It’s really a community collaboration,” Sacco said. “A lot of different groups work together to make it happen.”

The group, which is free, is open to everyone, whether they are recovering from addiction, have a family member or friend in recovery or just want to help out with events, mailings and other activities.
“It’s open to anybody who wants to be a part of that support system,” Sacco said, “and anybody who feels like they need support.”

Sacco said no particular recovery program is advocated by Friends of Recovery.
“Nothing is pushed,” she said. “We recognize faith-based programs, 12-step programs – we’re sort of non-denominational. Anything that works for people.”
The local organization was founded last September, Sacco said.

“In recognition of National Recovery Month, OASAS [New York State Office of Alcoholism and Substance Abuse Services] sponsored a luncheon at LeMoyne Manor in Liverpool,” she said. “The state wanted to expand their programs. Previously, the focus had been on treatment, then on prevention. The state wanted to focus on recovery and complete that triad.”

In order to come up with a program to address recovery services, people from across Onondaga County met for a brainstorming session.
“The goal was to set up places and organizations around the state for people in recovery to get services,” Sacco said.

Friends of Recovery was established as just such a resource. With an $11,000 grant from the Onondaga County Department of Mental Health, the group has been able to hold events, like their first, a family bowling night in November of 2007 that attracted some 500 people. They also host an annual Recovery Day celebration at the Inner Harbor; this year’s event took place on Saturday Sept. 13.

Friends of Recovery holds meetings on the second Wednesday of every month at which they discuss various programs and welcome addiction professionals as speakers. The meetings alternate between afternoons – 12 to 1:30 p.m. – and evenings – 5:30 to 7 p.m. – in order to accommodate anyone interested in coming. All meetings and events take place at the Salvation Army building, 667 South Salina St., Syracuse.
In addition to its regular meetings, Friends of Recovery has begun holding coffee hours at 7 p.m. on the first Tuesday of every month.

“It’s just an opportunity for a cup of coffee and some networking and fellowship with other people,” Sacco said. “You can come and just sit and drink coffee, or you can meet other people. There’s no agenda.”
The organization also offers family movie nights on the last Friday of the month.
“It’s a family event,” Sacco said. “It’s a lot of fun.”

The goal of the group is to not only provide support for those in recovery and their families, but also to remove the stigma attached to addiction.
“Addiction is recognized as a disease,” Sacco said. “Recovery from addiction is just like recovery from cancer or heart disease. You’re just as much a survivor for coming through that.”
For more information, e-mail FORCNY@yahoo.com.
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source: http://www.cnylink.com

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The nine personality types of heavy drinkers revealed

London, Sept 17 : If you think that alcohol drinkers are of only two kinds, that is, normal and alcoholics, then here's a piece of information: Britain's health bosses have identified nine different personality types.

The Brit government researchers have analysed people's social and psychological characteristics who regularly drink twice the recommended guidelines of alcohol.

They found that the personality types ranged from depressives who drink at home alone, to macho exhibitionists who spend almost every evening in the pub.

The information will be used to devise public health campaigns to target those who are putting themselves at risk of alcohol-related illnesses that cost the NHS in England about 2.7billion pounds a year.

"This will be a tough one to crack. Research found many positive associations with alcohol among the general public - even more so among those drinking at higher-risk levels," Telegraph quoted a DoH spokesman, as saying.

"For these people alcohol is embedded in their identity and lifestyle: so much so that challenging this behaviour results in high levels of defensiveness, rejection or even outright denial," the rep added.

The nine personality types of heavy drinkers are:

1 "De-stress drinkers" use alcohol to regain control of life and calm down.

2 "Conformist drinkers" are driven by the need to belong and seek a structure to their lives.

3"Boredom drinkers" consume alcohol to pass the time, seeking stimulation to relieve the monotony of life.

4 "Depressed drinkers" may be of any age, gender or socioeconomic group.

5 "Re-bonding drinkers" are driven by a need to keep in touch with people who are close to them.

6 "Community drinkers" are motivated by the need to belong.

7 "Hedonistic drinkers" crave stimulation and want to abandon control. They are often divorced people with grown-up children, who want to stand out from the crowd.

8 "Macho drinkers" spend most of their spare time in pubs.

9 "Border dependents" regard the pub as a home from home.
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source: http://www.thelondonnews.net

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New alcopops sneak around tax

THE maker of leading alcopop brands such as Vodka Cruiser and Pulse has found a way around the tax on premixed drinks: using alcohol derived from lower-taxed beer to attract younger drinkers back to the sweet stuff.

The arrival of the first Australian "malternative", as they are dubbed overseas, comes as nationwide alcohol consumption figures obtained by the Herald show the tax rise on ready-to-drink beverages in April is having a massive impact on sales and the broader consumption of alcohol.

The number of standard drinks consumed each week has fallen by 3 million since the alcopop tax rise, says a confidential report sent this week to key players in the alcohol industry by the research group Nielsen.

Leading suppliers in the once booming premixed category have been stunned by the collapse in sales since May, a trend confirmed in Nielsen's figures this week, which show there were 7 million fewer premixed standard drinks consumed between May and July compared with the same time last year.

While the figures show spirit and beer consumption is up, they have not offset the overall decline in alcohol consumption led by the stampede away from premixes.

"The total number of packaged liquor standard drinks has declined at a faster rate since the introduction of the [ready-to-drink] tax increase," Nielsen says.

The Federal Opposition has said it will block the tax in the Senate.

While premixed drink sales are down 26.2 per cent, spirits are up by 2.9 million standard drinks a week over the same period and beer is up by 1.1 million standard drinks a week.

But Nielsen's figures show the increase in beer and spirits consumption is still 3 million standard drinks less than the same time last year.

And it is why some in the spirits industry are very worried about disappearing profits.

One of the biggest players, Independent Distillers, told the Herald yesterday that it was about to launch Bolt, a "malternative" in three sweet flavours - raspberry, passionfruit and blueberry - designed to appeal to younger drinkers.

Bolt will be up to $25 a carton cheaper than spirits premixes because it is made with alcohol derived from beer - with all the beer taste characteristics stripped out during production.

A spokesman for Independent Distillers said it was not using a loophole in the new tax regime to launch a cheaper type of premixed beverage, but said it highlighted the problems of taxing spirits at a higher rate than beer.

Packaged beer is taxed at $39.40 a litre of pure alcohol while ready-to-drink beverages carry an impost of $66.70 a litre of pure alcohol.

Critics, however, said the "malternatives" and spirit premixes were developed to exploit the sweeter taste preferences of younger people and needed higher taxes to deal with social issues such as binge drinking.
RISE AND FALL

Since the alcopops tax increase:

- Sales in bottle shops have dropped by 7 million standard drinks a week, or 26.2 per cent

- Spirit sales have risen by 2.9 million standard drinks a week

- Packaged beer sales have risen by 1.1 million standard drinks a week

- Total liquor sales have fallen by 3 million standard drinks a week.
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Source: Nielsen

This story was found at: http://www.smh.com.au/articles/2008/09/15/1221330747912.html

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