Sober N Clean

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.
_________
source: health.com

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.
_______
source: Health Day News

Ottawa is determined to shut down Vancouver's safe-injection site because it's necessary to "draw a line" about which public health measures are acceptable, Canada's Health Minister says.

Tony Clement said that while the government supports needle exchanges as a legitimate intervention, providing a site to facilitate the injection of illegal drugs is going too far. He also invoked the slippery-slope argument.

"There are already people saying injection sites aren't enough, that true harm reduction is giving out heroin for free," the minister said.

"You have to draw the line somewhere and we feel we're drawing the line in a place Canadians are comfortable," Mr. Clement said in an interview in Mexico City, where he is attending the 17th International AIDS Conference.

Mark Townsend, a spokesman for the PHS Community Services Society, which helps run Insite, Vancouver's safe-injection site, called the notion "depressing silliness."

He said supervised injection sites provide better care for addicts and increase their likeliness to attend detox, so it makes little sense to throw support behind needle exchanges as a legitimate intervention.

"There's really little difference between needle exchanges and supervised injection sites, except for in a supervised injection site, there's a nurse there," Mr. Townsend said. "If you overdose, you don't die."

Earlier in the week, the World Health Organization issued a new guide for countries on how to best tackle the epidemic of HIV-AIDS that strongly endorsed a broad array of harm-reduction measures, including safe-injection sites.

Mr. Clement said that it is up to each country to decide what measures are appropriate, and "it's not my job to kowtow to orthodoxy."

The minister said intravenous drug use and its role in fuelling the epidemic of HIV-AIDS requires a mix of prevention, treatment and enforcement and he's convinced Canada has the balance right.

"I believe I'm on the side of compassion and on the side of the angels."

But Carolyn Bennett, the Liberal public health critic, balked at that suggestion, saying Mr. Clement "opposes supervised injection sites yet says he supports needle exchange, which makes no medical sense."

She said the Conservative government's stand is driven by ideology, not compassion, and accused Mr. Clement of "embarrassing Canada" on the world stage.

At the Mexico City conference, Canada has also been under fire for what some call its paltry contribution to the fight against AIDS, both domestically and internationally.

Julio Montaner, a Vancouver physician who heads the International AIDS Society, told Mr. Clement that Canada should be ashamed that it is not contributing as much, per capita, as its neighbour to the south.

Last week, U.S. President George W. Bush approved a plan to spend $48-billion (U.S.) over the next five years on AIDS programs.

Currently, Canada invests a fraction of what the United States does: $550-million over the past three years on HIV-AIDS programs abroad. In Mexico, Mr. Clement announced an additional $45-million in funding.

"I acknowledge that it's not $45-billion but it's commensurate with Canada's abilities," the minister said.

Mr. Clement said Ottawa is spending $84.4-million on AIDS programs this year, the highest amount in its history.
________
source: The Globe and Mail, http://www.theglobeandmail.com

It's a sobering thought for women who enjoy a few drinks at the end of a long day.

A new study has found that women who drink even moderate amounts of alcohol face a substantially increased risk - up to 50 per cent higher - of developing a common type of breast cancer.

"Even a drink a day can cause an increased risk," said Jasmine Lew, a fourth-year medical student at the University of Chicago who received a scholarship to conduct research at the National Cancer Institute in the United States.

The study, being presented at this week's American Association for Cancer Research annual meeting, seems to high- light the need for women to evaluate their levels of alcohol consumption.

Researchers examined data of nearly 185,000 postmenopausal women in the United States collected by the National Institutes of Health. About 70 per cent of women reported some level of alcohol intake. After following the women for seven years, researchers found that women who consumed three or more drinks a day had about a 50-per-cent increase in their risk for developing estrogen receptor positive, progesterone receptor positive breast cancer, which is one of the most common types.

Women who reported drinking one to two drinks a day had a 32-per-cent increase in breast cancer risk, while those who consumed, on average, less than one drink of alcohol a day had about a 7-per-cent increased risk.

"The more you drink, the higher your risk, the relative risk, of getting breast cancer," Ms. Lew said. "I think what should be taken from [the study] is that alcohol consumption is positively associated with breast cancer."

Although more research must be done to determine whether alcohol actually influences the development of breast cancer, the findings indicate a conclusive association between alcohol intake and possible risk, Ms. Lew said.

The findings appear to present further evidence that alcohol may increase the amount of estrogen metabolites in a woman's body, which may contribute to the development of hormone-sensitive breast cancer, according to the study.

The study is the latest in a growing collection of research that is demonstrating the significant consequences that alcohol can have on health.

"Alcohol is quite a toxic drug," said Tim Stockwell, director of the Centre for Addictions Research of British Columbia at the University of Victoria. "The sad fact is there are approximately 60 ways in which alcohol can kill a person or cause them to be very ill."

It's a growing problem in an era when binge drinking is increasingly socially acceptable, Dr. Stockwell said.

"Nearly all the provinces are going through a phase of increased consumption and have been across Canada for about the last 10 years," he said. "When that overall consumption goes up, drinking at all age groups tends to go up."

Numerous medical studies have found small amounts of alcohol have a positive effect on health and can protect against certain diseases. For instance, studies suggest that moderate amounts of red wine may reduce a person's risk of developing heart disease.

The problem is that people often drink beyond the small doses that could provide such benefits, Dr. Stockwell said.

He also said it's possible that some studies linking moderate consumption with positive benefits may be misleading, because people who report themselves as moderate to light drinkers may be more likely to be in good health than heavy drinkers.

WOMEN have been warned that they risk seriously damaging their health if they adopt a new fad diet which encourages boozing instead of eating.

Drunkorexia is the latest craze to come from the US which showbiz insiders claim is followed by Hollywood stars including Lindsay Lohan, Mischa Barton, Tara Reid and Paris Hilton.

Perhaps the most famous drunkorexic of all time is Patsy in Absolutely Fabulous, who famously lived on Bolly and Stoli, who only once, in the entire history of the sitcom, ever asked for “some of that food stuff” and who was fashionably skeletal.

Now UK health experts are increasingly worried that more and more women are following the trend in order to stay slim while drinking heavily.

Denying themselves two biscuits would allow an average woman to drink three vodkas and diet colas without gaining any weight.

And cutting out the 700 calories found in a serving of spaghetti bolognese means a woman could drink up to five alcopops without piling on the pounds.

Some health experts blame diets which encourage calorie counting for supporting the trend.

Professor Janet Treasure, head of the Eating Disorder Unit at the Institute of Psychiatry in London, described drunkorexia as “very dangerous”.

“It is more common with bulimia than anorexia, but you get the combination of empty calories with no nutritional value, and the risky behaviour that goes with being drunk.”

Marie Griffiths of the Wales-based Slimtone weight loss organisation said: “Any social life includes eating and drinking alcohol.

“I know a lot of people who will factor in the odd glass of wine into their weekly calorie intake.

“But cutting out a healthy diet in order to drink heavily obviously could be very detrimental to your health. Liver complaints are on the rise in young women already.

“And if you don’t eat all day then go out drinking, your blood sugar levels will be so low that whatever you drink will affect you that much more.”

Endorsements for dumping healthy food for alcohol are easily found on social networking sites, including Facebook.

The creator of the Anorexia Binge Drinking Diet society, which has at least one registered member from Wales, writes: “Anyone trying to lose weight and look good for the ladies?

“I created a new diet for everyone in college. Don’t eat all day, then go get s***faced every night. Drink until you throw up!

“No calories, you have to lose weight. ( I think).”

And the Binge Drinking Appreciation Group includes in its justification of binge-drinking: “If you’re going to be a fat b*****d in your later years, you may as well enjoy the process.”

In one of the most comprehensive studies into the link between alcohol and food suppression, research suggested that people with eating disorders are five times more likely to be substance abusers, while substance abusers are 11 times more likely to have eating disorders.

The study also noted that eating disorders and substance abuse have several significant characteristics in common – brain chemistry, family history, stress triggers and the prevalence of affected people also suffering from low self-esteem, depression, anxiety or a history of abuse.

Mary George, spokeswoman for eating disorders charity b-eat, said: “Drunkorexia is a form of behaviour more associated with binge- drinking than eating disorders.

“We are aware of it, but it is in some ways almost belittling to put it in the same bracket as eating disorders, which are a form of mental illness.

“Having said that, it is certainly not something which we would condone, or dismiss.”

And Mary Wood, chief executive of the eating-disorder charity Foundations UK, said: “It’s hard to generalise about the link between eating disorders and alcohol. There are so many ways in which the two work together – psychologically, physiologically and culturally.

“One thing is certain, however: all eating disorders are a way of coping with emotional pain, and so is alcohol.”

source: Celtic Weekly Newspapers

A study in a Wiley-Blackwell journal - Respirology - finds that the development of bullous lung disease occurs in marijuana smokers approximately 20 years earlier than tobacco smokers.

A condition often caused by exposure to toxic chemicals or long-term exposure to tobacco smoke, bullous lung disease (also known as bullae) is a condition where air trapped in the lungs causes obstruction to breathing and eventual destruction of the lungs.

At present, about 10% of young adults and 1% of the adult population smoke marijuana regularly. Researchers find that the mean age of marijuana-smoking patients with lung problems was 41, as opposed to the average age of 65 years for tobacco-smoking patients.

The study "Bullous Lung Disease due to Marijuana" also finds that the bullous lung disease can easily go undetected as patients suffering from the disease may show normal chest X-rays and lung functions. High-resolution CT scans revealed severe asymmetrical, variably sized bullae in the patients studied. However, chest X-rays and lung functions were normal in half of them.

Lead author Dr. Matthew Naughton says, "What is outstanding about this study is the relatively young ages of the lung disease patients, as well as the lack of abnormality on chest X-rays and lung functions in nearly half of the patients we tested."

He added, "Marijuana is inhaled as extremely hot fumes to the peak inspiration and held for as long as possible before slow exhalation. This predisposes to greater damage to the lungs and makes marijuana smokers are more prone to bullous disease as compared to cigarette smokers."

Patients who smoke marijuana inhale more and hold their breath four times longer than cigarette smokers. It is the breathing manoeuvres of marijuana smokers that serve to increase the concentration and pulmonary deposition of inhaled particulate matter - resulting in greater and more rapid lung destruction.

This paper is published in the January 2008 issue of Respirology.

source: medilexicon.com

Canadians who are prescribed marijuana to treat their illnesses will no longer be forced to rely on the federal government as a supplier following a Federal Court ruling that struck down a key restriction in Ottawa's controversial medical marijuana program.

The decision by Judge Barry Strayer, released late Thursday, essentially grants medical marijuana users more freedom in picking their own grower and allows growers to supply the drug to more than one patient.

It's also another blow to the federal government, whose attempts to tightly control access to medical marijuana have prompted numerous court challenges.

Currently, medical users can grow their own pot but growers can't supply the drug to more than one user at a time.

Lawyers for medical users argued that restriction effectively established Health Canada as the country's sole legal provider of medical marijuana.

They also said the restriction was unfair, and that it prevented seriously ill Canadians from obtaining the drug they needed to treat their debilitating illnesses.

In his decision, Strayer called the provision unconstitutional and arbitrary, as it "caused individuals a major difficulty with access…"

Ottawa must also reconsider requests made by a group of medical users who brought the matter to court to have a single outside supplier as their designated producer, Strayer said in his 23-page decision.

While the government has argued that medical users who can't grow their own marijuana can obtain it from its contract manufacturer, fewer than 20 per cent of patients actually use the government's supply, Strayer wrote.

"In my view it is not tenable for the government, consistently with the right established in other courts for qualified medical users to have reasonable access to marijuana, to force them either to buy from the government contractor, grow their own or be limited to the unnecessarily restrictive system of designated producers," he wrote.

Ron Marzel, a Toronto lawyer representing the group of medical users who brought the matter before the Federal Court, called the decision a "great remedy" for his clients.

"All this means is that the limit — the one-to-one ratio — it's the last nail in the coffin for that ratio," he said in an interview.

"The court has said, 'Look, unequivocally, this is unconstitutional, it's arbitrary. All the reasons you've provided us with so far for this one-to-one ratio, they don't pass muster. We don't buy it, we don't accept it."'

The provision had been struck down by the courts before, but was reinstated by the government who contracted Prairie Plant Systems Inc. in Flin Flon, Man., to provide the drug to patients.

source: Canadian Broadcasting Corporation

Drinking heavily, craving alcohol, inability to limit the number of drinks one has, a dependence on alcohol and the need to drink more and more to get a ‘‘buzz” — these are the classic symptoms of alcoholism.

Alcoholism is a chronic disease. It lasts a lifetime and follows a predictable course. It is incurable, and it can be fatal. But it can be treated.

The negative effects of too much alcohol on a person’s health are widely known. Liver disease, circulatory problems, accidents, and for women who abuse alcohol while pregnant, a host of health problems for their unborn child can occur. The social problems associated with alcoholism and alcohol abuse are generally well known, too. Violence, poverty, homelessness, crime and neglect head the list.

Alcoholism has no regard for gender, race, nationality, social status, education, or wealth. An estimated one out of every 13 adult Americans may be an alcoholic.

Alcohol abuse and alcoholism are serious health and social issues. They are also matters that have a profound effect on the workplace. Research suggests that alcohol misuse decreases workplace productivity and increases injuries and absenteeism.

Furthermore, a study conducted by the Harvard School of Public Health and supported by a grant from the Robert Wood Johnson Foundation sheds some interesting light on perceptions about alcohol abuse in the work environment.

The study found that many business people believe:

• That alcohol related work performance problems are caused by a few problem drinkers. The finding is that the majority of the problems are caused by non-dependent workers.



• That drinking while on the job is the core issue. The finding is that drinking the night before or immediately before work are just as problematic.



• That drinking problems are generally confined to unskilled and hourly workers. The finding is that managers and supervisors are actually more likely to drink during the work day.



• That current company policies toward drinking are effective and the company has little influence on employee drinking away from the workplace. The findings suggest that company policies are often not well-implemented and that the company’s culture can influence drinking away from work.

The Maryland Affiliate, National Council on Alcoholism and Drug Dependence, Maryland Chapter, provides education, information, and help in the fight against alcoholism by focusing on prevention, intervention, research and treatment.

source: The Gazette

British songstress Amy Winehouse, who croons "no, no, no" to rehab, has a lot of American company this time of year - both in her heavy-drinking ways and her unwillingness to spend weeks in a specialized facility to get sober.

But experts say there might be new hope for rehab refuseniks like Winehouse and an estimated 5.7 million alcoholics in the United States who are not in treatment - hope that could be as close as the family doctor.

New research and a growing arsenal of medications have set the stage for a major shift in the treatment of alcoholism, from specialized clinic to the "primary care office setting," the Journal of the American Medical Association reported in its Dec. 5 issue.

But if the promise of "office-based" treatment of alcoholism is to become a reality, the nation's 337,000 general-practice physicians - and the systems within which they work - will have to undergo some transformation themselves, addiction experts say.

Doctors must overcome their reluctance to broach the subject of drinking and learn how best to intervene when they suspect alcoholism. Medical practices might need to add staff to help counsel recovering patients. And insurance companies and federal insurance programs will need to be persuaded to reimburse patients for medication that can be costly and to pay physicians for taking on a new role in patients' care.

Several new drugs are making office-based treatment a realistic prospect. In April 2006, a monthly injectable form of the drug naltrexone won approval from the Food and Drug Administration. Marketed as Vivitrol, the new formulation of a long-available drug can be started after only four days of abstinence and appears to cause less nausea than pills taken daily - features that make it easier for patients to start and stay on the treatment. It joined two other medications approved to curb alcohol cravings.

Evidence is growing for the effectiveness of these and other addiction medications, such as the anti-convulsive drug topiramate, which, although not FDA-approved for this purpose, is widely prescribed off-label to help alcoholics stay away from drink. And more FDA approvals for drugs that treat alcohol dependence are on the horizon.

At the same time, studies published this year underscored the effect that a few frank words from the doctor can have on patients whose drinking appears to have become excessive.

These developments could be the "tipping point" into a new era of alcohol treatment, says Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. With new confidence in their powers of persuasion and new pharmaceutical tools in their black bags, primary care physicians - who have been notoriously shy of confronting patients about their drinking habits - might grow more willing to flag an alcohol problem, offer medication and dispense advice during routine office visits, Willenbring says.

In turn, as patients grow more confident that they can curb their drinking without the time, expense and stigma of a stay in a clinic, more probably will step forward for help.

"In many ways, we are with alcoholism where we were with depression 30 years ago," Willenbring says. As a new generation of antidepressants came to market in the early 1980s, physicians on the front lines of patient care grew more attentive to the signs of depression and more willing to treat it. Patients with protracted bouts of blue mood turned to their family doctors for help in increasing numbers.

In the process, depression was transformed from a highly stigmatized mental illness that rarely was treated before a suicide attempt or outside a psychiatric hospital to a condition for which 80 percent of patients turn first to a general medical practitioner.

A similar shift in the treatment of alcohol-related disorders won't happen overnight, Willenbring says. But with 19.5 million Americans thought to have alcohol-related disorders in 2006, and only 1.6 million getting specialized treatment, "We have to start thinking creatively about how to provide more accessible, appealing and creative options," he says, to encourage patients with drinking problems to get the help they need before they hit the skids.

Experts warn, however, that as general-care physicians armed with medications shoulder a greater role in treating alcohol dependence, patients and public officials must ensure that the sickest patients do not suffer in a rush to treat alcoholism more economically.

In that regard, not all experts see depression treatment as an encouraging example. Medication has worked wonders for many depressed patients. But a study published in 2001 found that only about one-quarter of depressed patients seeing a general practitioner got appropriate care. Meanwhile, insurance companies keen to reduce spending for depression care have limited patients' access to costly psychotherapy, despite studies showing that patients improve most when such therapy is paired with medication.

As anti-alcoholism drugs show gains in effectiveness, many people fear that insurance companies and federally supported programs will rely largely on medications and the brisk medical management of primary-care doctors.

That, they fear, could deny alcoholics who need the extra support of intensive rehabilitation the care they need to quit.

"You'd have to be naive not to be a little concerned that that will happen," says Mitchell Karno, a treatment researcher at the University of California, Los Angeles.

Doctors, too, must make changes if this new era of "office-based" alcohol treatment is to become a reality, experts say - and some aren't convinced that the changes will happen easily.

"It's a vision that has some benefits to it, but it's not a done deal at this point," says Richard Rawson, associate director of UCLA Medical School's Integrated Substance Abuse Programs.

Rawson observed one crucial obstacle when he tried to launch a pilot program in which U.S. primary care doctors would screen patients for risky or excessive alcohol use and provide "brief interventions" intended to get those with problems to quit or reduce their alcohol consumption.

In all, the prescribed screening and intervention initiative would have taken physicians 10 minutes, Rawson says. He approached five institutions in an effort to recruit support.

None agreed.

"What we hear over and over again is, "Look, we have seven minutes to do whatever it is we're going to do. To take five minutes to do screening and then another five to do a brief intervention on this one dimension of health problems is just not in the cards,"' Rawson says. "I don't think we're at a point where we can just dump it all in the laps of primary care docs."

Physicians frequently hesitate to raise the question unless a patient is showing clear evidence of alcohol-related damage - including impaired liver function, high triglycerides or bloated red blood cells. "It's like, 'Don't ask, don't tell,'" says New York internist Dr. Steven Lamm, who successfully has treated a number of patients with medication, including the monthly injectable version of naltrexone. That's especially been the case, he adds, because of the perceived paucity of medical treatments they have to offer. "What are you going to do about it? Send them to Alcoholics Anonymous?" he says.

In the new climate, such reluctance might change.

As pharmaceutical companies launch new drugs - and new marketing campaigns for them - doctors will grow more assertive about raising the issue, says UCLA geriatrician Dr. Alison Moore, who sits on a panel at Willenbring's NIAAA that reviews the effectiveness of alcoholism treatments.

But, Moore adds, in addition to writing prescriptions for new drugs, physicians also had better learn new ways for how to talk to patients about their alcohol problems and where to refer them if they need more help than a pill or an injection can provide.

"They're better than nothing," Moore says of the available medications. "But I don't see them as wonder drugs." They don't work for all patients, and even when they do, patients frequently relapse, she adds.

A new era in alcohol treatment also might bring new definitions of sobriety, as well, experts say. Programs such as Alcoholics Anonymous, as well as most people who treat alcoholism, have always drawn a clear line between sober - completely abstaining from alcohol - and alcoholic.

As alcohol treatment grows more accessible, however, a wider range of patients - including those who are not alcohol-dependent, but who endanger their health by drinking to excess - are expected to come forward for treatment. For these patients, support groups like Alcoholics Anonymous might be less relevant than newer groups such as SMART Recovery and Rational Recovery, less ubiquitous than AA, which emphasize a goal of moderation in drinking.

In January, the NIAAA will launch a print- and Web-based self-help program called "Rethinking Drinking," aimed at a wide range of drinkers, including those with what Willenbring calls "a mild form of alcohol dependence."

The emergence of these alternatives to AA is certain to reignite a long-running debate over what goals alcoholism treatment should embrace. And it probably will spark efforts to define more broadly the range of patients who have a drinking problem, as well as those who could benefit from preventive or early treatment.

A nationwide study of 7,751 emergency room patients has confirmed that visits to the E.R. provide a great opportunity to use brief interventions to reduce harmful drinking. Asking emergency department patients about their alcohol use and talking with them about how to reduce harmful drinking patterns is effective in reducing drinking, the study found.

In the study, conducted at 14 university-based emergency centers, researchers use a brief questionnaire to access the alcohol consumption of 7,751 patients, even if they had no signs of alcohol use when they were admitted. They found one-fourth of the patients qualified as harmful drinkers -- four drinks a day for men, three for women.

Of those patients, 1,100 agreed to participate in the study. They were divided into two groups, on e receiving intervention and one control group. Their drinking patterns were assessed again after three months.

Brief Negotiated Interview

The intervention group received a Brief Negotiated Interview (BNI) from E.R. personnel, written information about low-risk drinking, and a list of alcohol treatment providers. Patients in the control group received only the handout and referral list.

After three months, the intervention group reported drinking three fewer drinks per week than the control group, and more than one-third of the intervention group reported drinking at low-risk levels, compared with about one-fifth of those in the control group.

"The BNI, a conversation between emergency care providers and patients that involves listening rather than telling, and guiding rather than directing, is designed to review the patient's current drinking patterns, assess their readiness to change, offer advice about the low-risk guidelines and the next steps to pursue, and negotiate a written prescription for change or a drinking agreement with the patient," said co-author Edward Bernstein, M.D., of Boston University School of Medicine.

Brief Intervention Works

To prepare for the study, Dr. Bernstein trained more than 400 emergency department healthcare workers, including physicians, nurses, social workers, nurse practitioners and physician's assistants, how to conduct the 10-minute Brief Negotiated Interviews.

The study confirms previous studies that have shown that screening and brief intervention in primary care and in-patient trauma centers have been effective in reducing harmful drinking patterns, reducing injury rates and reducing costs to society.

The study was published in the December 2007 issue of the Annals of Emergency Medicine.

source: about.com

Addiction medication and sage advice could be dispensed from a physician's office.

British songstress Amy Winehouse, who croons "no, no, no" to rehab, has a lot of American company this time of year -- both in her heavy-drinking ways and her unwillingness to spend weeks in a specialized facility to get sober.

But experts say there may be new hope for rehab refuseniks like Winehouse and an estimated 5.7 million alcoholics in the United States who are not in treatment -- hope that could be as close as the family doctor.

New research and a growing arsenal of medications have set the stage for a major shift in the treatment of alcoholism, from specialized clinic to the "primary care office setting," the Journal of the American Medical Assn. reported in its Dec. 5 issue.

But if the promise of "office-based" treatment of alcoholism is to become a reality, the nation's 337,000 general-practice physicians -- and the systems within which they work -- will have to undergo some transformation themselves, addiction experts say.

Doctors must overcome their reluctance to broach the subject of drinking and learn how best to intervene when they suspect alcoholism. Medical practices may need to add staff to help counsel recovering patients. And insurance companies and federal insurance programs will need to be persuaded to reimburse patients for medication that can be costly and to pay physicians for taking on a new role in patients' care.

Several new drugs are making office-based treatment a realistic prospect. In April 2006, a monthly injectable form of the drug naltrexone won approval from the Food and Drug Administration. Marketed as Vivitrol, the new formulation of a long-available drug can be started after only four days of abstinence and appears to cause less nausea than pills taken daily -- features that make it easier for patients to start and stay on the treatment. It joined two other medications approved to curb alcohol cravings.

Evidence is growing for the effectiveness of these and other addiction medications, such as the anti-convulsive drug topiramate, which, although not FDA-approved for this purpose, is also widely prescribed off-label to help alcoholics stay away from drink. And more FDA approvals for drugs that treat alcohol dependence are on the horizon.

At the same time, studies published this year underscored the effect that a few frank words from the doctor can have on patients whose drinking appears to have become excessive.

These developments could be the "tipping point" into a new era of alcohol treatment, says Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. With new confidence in their powers of persuasion and new pharmaceutical tools in their black bags, primary care physicians -- who have been notoriously shy of confronting patients about their drinking habits -- may grow more willing to flag an alcohol problem, offer medication and dispense advice during routine office visits, Willenbring says.

In turn, as patients grow more confident that they can curb their drinking without the time, expense and stigma of a stay in a clinic, more will likely step forward for help.

Parallel with depression

"In many ways, we are with alcoholism where we were with depression 30 years ago," Willenbring says. As a new generation of antidepressants came to market in the early 1980s, physicians on the front lines of patient care grew more attentive to the signs of depression and more willing to treat it. Patients with protracted bouts of blue mood turned to their family doctors for help in increasing numbers.

In the process, depression was transformed from a highly stigmatized mental illness that was rarely treated before a suicide attempt or outside a psychiatric hospital to a condition for which 80% of patients turn first to a general medical practitioner.

A similar shift in the treatment of alcohol-related disorders won't happen overnight, Willenbring says. But with 19.5 million Americans thought to have alcohol-related disorders in 2006, and only 1.6 million getting specialized treatment, he says, "we have to start thinking creatively about how to provide more accessible, appealing and creative options" to encourage patients with drinking problems to get the help they need before they hit the skids.

Experts warn, however, that as general-care physicians armed with medications shoulder a greater role in treating alcohol dependence, patients and public officials must ensure that the sickest patients do not suffer in a rush to treat alcoholism more economically.

In that regard, not all experts see depression treatment as an encouraging example. Medication has worked wonders for many depressed patients. But a study published in 2001 found that only about one-quarter of depressed patients seeing a general practitioner got appropriate care. Meanwhile, insurance companies keen to reduce spending for depression care have limited patients' access to costly psychotherapy, despite studies showing that patients improve most when such therapy is paired with medication.

As anti-alcoholism drugs show gains in effectiveness, many fear that insurance companies and federally supported programs will rely largely on medications and the brisk medical management of primary-care doctors.

That, they fear, could deny alcoholics who need the extra support of intensive rehabilitation the care they need to quit.

"You'd have to be naive not to be a little concerned that that will happen," says Mitchell Karno, UCLA's alcohol treatment researcher.

Doctors, too, will have to make changes if this new era of "office-based" alcohol treatment is to become a reality, experts say -- and some aren't convinced that the changes will easily happen.

"It's a vision that has some benefits to it, but it's not a done deal at this point," says Richard Rawson, associate director of UCLA Medical School's Integrated Substance Abuse Programs.

Rawson observed one crucial obstacle when he tried to launch a pilot program in which U.S. primary care doctors would screen patients for risky or excessive alcohol use and provide "brief interventions" intended to get those with problems to quit or reduce their alcohol consumption.

In all, the prescribed screening and intervention initiative would have taken physicians 10 minutes, Rawson says. He approached five institutions in an effort to recruit support.

None bit.

"What we hear over and over again is, 'Look, we have seven minutes to do whatever it is we're going to do. To take five minutes to do screening and then another five to do a brief intervention on this one dimension of health problems is just not in the cards,' " Rawson says. "I don't think we're at a point where we can just dump it all in the laps of primary care docs."

Rawson adds that in addition to physician training, other things would also have to change to account for the new demands -- such as systems of payment, insurance reimbursement and the office structure of general care practitioners.

Another obstacle experts see: Doctors are generally wary of challenging patients in matters that involve emotionally charged personal habits such alcohol consumption as well as smoking and obesity. And patients, in any case, almost always lie about their habits.

Physicians frequently hesitate to raise the question unless a patient is showing clear evidence of alcohol-related damage -- including impaired liver function, high triglycerides or bloated red blood cells. "It's like, 'Don't ask, don't tell,' " says New York internist Dr. Steven Lamm, who has successfully treated a number of patients with medication, including the monthly injectable version of naltrexone. That's especially been the case, he adds, because of the perceived paucity of medical treatments they have to offer. "What are you going to do about it? Send them to Alcoholics Anonymous?" he says.

Change is in the air

In the new climate, such reluctance might change.

As pharmaceutical companies launch new drugs -- and new marketing campaigns for them -- doctors will grow more assertive about raising the issue, says UCLA geriatrician Dr. Alison Moore, who sits on a panel at Willenbring's NIAAA that reviews the effectiveness of alcoholism treatments.

But, Moore adds, in addition to writing prescriptions for new drugs, physicians also had better learn new scripts for how to talk to patients about their alcohol problems and where to refer them if they need more help than a pill or an injection can provide.

"They're better than nothing," Moore says of the available medications. "But I don't see them as wonder drugs." They don't work for all patients, and even when they do, patients frequently relapse, she adds.

A new era in alcohol treatment may also bring new definitions of sobriety, as well, experts say. Programs such as Alcoholics Anonymous, as well as most of those who treat alcoholism, have always drawn a clear line between sober -- completely abstaining from alcohol -- and alcoholic.

As alcohol treatment grows more accessible, however, a wider range of patients -- including those who are not alcohol-dependent, but who endanger their health by drinking to excess -- are expected to come forward for treatment. For these patients, support groups like Alcoholics Anonymous may be less relevant than newer groups such as SMART Recovery and Rational Recovery, less ubiquitous than AA, which emphasize a goal of moderation in drinking.

In January, the NIAAA will launch a print- and Web-based self-help program called "Rethinking Drinking," aimed at a wide range of drinkers, including those with what Willenbring calls "a mild form of alcohol dependence."

The emergence of these alternatives to AA is certain to reignite a long-running debate over what goals alcoholism treatment should embrace. And it will likely spark efforts to define more broadly the range of patients who have a drinking problem, as well as those who could benefit from preventive or early treatment.

UCLA's Mitchell Karno says that patients and their family doctors will likely work out their own solutions. "People will seek out the level of treatment that's going to match their need," Karno says -- whether it's eight weeks in rehab, or a pill, an encouraging word from the doc and a self-help book.

Between strict abstinence and a safer level of drinking, Karno says, "it will be up to physicians and patients to choose how they're going to negotiate that tension."

source: Los Angeles Times
melissa.healy@latimes.com

New research into lifelong alcohol consumption reveals that heavy binge drinking by adolescents and young adults is associated with increased long-term risk for heart disease, high blood pressure, type 2 diabetes, and other metabolic disorders. The risk is lower in people who start drinking alcohol later in life and maintain more moderate drinking patterns.

The study, accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM), also indicates that the increased health risks were independent of the total amount of alcohol consumed over a lifetime, or whether or not people stopped or curtailed drinking as they matured.

"To fully understand the effect of alcohol consumption on health, you need to consider lifetime drinking patterns," said Dr. Marcia Russell of the Pacific Institute for Research and Evaluation's Prevention Research Center in Berkeley, Calif., and senior author of the study. "Early initiation of alcohol drinking and heavy drinking in adolescence and early adulthood seem to be associated with a number of adverse health effects collectively known as the metabolic syndrome.”

The term metabolic syndrome describes a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke, and type 2 diabetes. The exact cause of the metabolic syndrome is not known, but genetic factors, too much body fat (especially in the waist area), and lack of exercise increase the risk of developing the condition.

Russell and her colleagues based their research on data from the Western New York Health Study (WNYHS), conducted between 1996 and 2001. This study retrospectively collected lifestyle information on more than 2,800 people who reported that they were regular drinkers at one point in their lives. The study also collected data on the prevalence of the metabolic syndrome and its individual components, including obesity, high triglycerides, low HDL cholesterol, elevated blood pressure, and high fasting glucose.

The WNYHS study revealed two distinct lifetime drinking trajectories among people who were ever regular drinkers. Drinking trajectory refers to the variability in drinking behavior over the span of a person's lifetime.

Early peak lifetime trajectories were characterized by early and heavy drinking followed by a sharp reduction in alcohol intake. Stable trajectories were characterized by more moderate intakes over a longer period of life. Lifetime drinking patterns included total years of drinking, first and last age of regular drinking, total volume of alcohol consumed, and many other factors. Early peak drinkers were, on average, 10 years younger than stable drinkers. Despite this age difference, the early peak drinkers still had a modestly higher risk of developing metabolic syndrome.

“Drinking patterns associated with early peak and stable drinking trajectories were distinctly different,” said Russell. “Early peak drinkers generally began drinking earlier than stable drinkers. They drank fewer years, less frequently, and consumed less volume of alcohol over their lifetimes, but averaged more drinks per drinking day and had higher rates of episodic heavy drinking and intoxication.”

The researchers speculate that the reason for the increased risk for metabolic syndrome found in the study may be associated with the adverse health effects of early unhealthy drinking patterns, which were carried over to later life. Also, early peak drinkers may have adopted other lifestyle habits detrimental to cardio-metabolic health.

The lead author of the study is Dr. Amy Fan, also of the Prevention Research Center. Other study authors include Dr. Saverio Stranges of the University at Buffalo, N.Y., and the University of Warwick, U.K.; and Drs. Joan Dorn and Maurizio Trevisan of the University of Buffalo.

source: Newswise

Twenty one children a day are taken to hospital after binge drinking and teenagers are being treated for alcohol-related liver diseases formerly seen only in the elderly, it was revealed.

The Alcohol Health Alliance coalition says drink kills more people than breast and cervical cancer and MRSA together, with rates for cirrhosis of the liver doubling since 2000.

Official figures show that 7,579 under-18s were admitted to hospital suffering from the effects of alcohol in the 12 months from April 2004.

That is 21 a day and is almost double the previous year's figure.

The alliance was launched yesterday after scientists called for 24-hour drinking to be scrapped, blaming it for a rise in violent crime and turning streets into "vomit alleys".

The coalition of 24 charities, medical bodies and patients' groups wants the Government to increase the tax on alcohol, saying a rise of 10 per cent would cut alcohol-related deaths by up to 30 per cent.

It is also demanding a cut in the drink- driving limit and a ban on alcohol advertising on TV before 9pm and in cinemas before all films except those rated for 18-year-olds.

The alliance also called for more funding for the treatment of alcoholics and more publicity about the toxic effects of heavy drinking and mental and behavioural problems caused by alcohol.

Professor Ian Gilmore, chairman of the alliance and president of the Royal College of Physicians, said: "Unless we act now to stem the rising tide of excessive drinking, particularly in the young, we will see yet more people dying prematurely in early adult life."

A BBC survey of hospital consultants found they are now treating patients in their early twenties with alcohol-related hepatitis, which formerly did not affect people until their fifties.

Women in their thirties are being treated for cirrhosis of the liver. One consultant was treating a 19-year-old woman with terminal liver disease, while another

woman died of advanced cirrhosis at 24.

Dr John O'Grady, of the British Association for the Study of the Liver, said the UK is the only developed nation still seeing a rise in liver disease.

He added: "Every year 150,000 people are admitted to hospital suffering from alcohol-related injury or disease and 22,000 die prematurely, including 5,000 from liver disease.

"Although a considerable amount of taxation is generated from alcohol, alcohol is a massive burden on society.

"This new alliance will be playing a vital part in highlighting the growing problem and hopefully, by promoting responsible drinking habits, dramatically reduce the section of society currently on course for an early grave."

Chris Russell, of the Royal College of Surgeons of England, said: "Surgeons see some of the most immediate effects of bingedrinking in a rising toll of emergency trauma injury admissions due largely to traffic accidents and alter-cations."

Yesterday the Nuffield Council on Bioethics called for increased taxes on drink, restrictions on advertising and the suspension of round-the-clock drinking.

But Jeremy Beadles, of the Wine and Spirit Association, said: "The people clamouring for an increase in taxes and regulation on the drinks industry ignore the fact that alcohol consumption is actually falling.

"Increasing the cost of alcohol will just hit the vast majority who enjoy a drink in moderation."

• Young people are boozing at home before they go out, to get a head start with their drinking.

"Pre-loading" fuelled by cheap alcohol is behind increasing drunkenness and violence among Britons aged 18 to 35. More than half say they pre-load before leaving to go drinking on the town.

Alcohol consumption on a night out was 16.3 units for women and 23.7 for men, a study by the Centre for Public Health at Liverpool John Moores University found.

But pre-loaders were four times more likely to drink at least 20 units a night and two and half times more likely to have been in a fight while out drinking.

The weekly alcohol limit is 14 units for women and 21 for men.

A unit is equal to half a pint of cider or beer, a small glass of wine or a 25ml measure of spirit.

source: The Daily Mail