Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism (ALCOHOL RES HEALTH)

Publications in this journal

• Article: Environmental Approaches to Prevention in College Settings.

  Robert F Saltz
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  ABSTRACT: Because of concerns regarding drinking among college students and its harmful consequences, numerous prevention efforts have been targeted to this population. These include individual-level and community-level interventions, as well as other measures (e.g., online approaches). Community-level interventions whose effects have been evaluated in college populations include programs that were developed for the community at large as well as programs aimed specifically at college students, such as A Matter of Degree, the Southwest DUI Enforcement Project, Neighborhoods Engaging With Students, the Study to Prevent Alcohol-Related Consequences, and Safer California Universities. Evaluations of these programs have found evidence of their effectiveness in reducing college drinking and related consequences. The most effective approaches to reducing alcohol consumption among college students likely will blend individual-, group-, campus-, and community-level prevention components.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 12/2011; 34(2):204-209.
• Article: Defining risk drinking.

  Deborah A Dawson
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  ABSTRACT: Many efforts to prevent alcohol-related harm are aimed at reducing risk drinking. This article outlines the many conceptual and methodological challenges to defining risk drinking. It summarizes recent evidence regarding associations of various aspects of alcohol consumption with chronic and acute alcohol-related harms, including mortality, morbidity, injury, and alcohol use disorders, and summarizes the study designs most appropriate to defining risk thresholds for these types of harm. In addition, it presents an international overview of low-risk drinking guidelines from more than 20 countries, illustrating the wide range of interpretations of the scientific evidence related to risk drinking. This article also explores the impact of drink size on defining risk drinking and describes variation in what is considered to be a standard drink across populations. Actual and standard drink sizes differ in the United States, and this discrepancy affects definitions of risk drinking and prevention efforts.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(2):144-56.
• Article: Combination drug use and risk for fetal harm.

  Weijung A Chen, Susan E Maier
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  ABSTRACT: Alcohol and other drugs are frequently used in combination. Based on data from the National Epidemiologic Survey on Alcohol and Related Conditions, Falk and colleagues (2006, 2008) reported that 21.7 percent of the sampled population used both alcohol and tobacco and 5.6 percent used alcohol and another drug. Among women aged 18 to 24 the rates were 25.5 percent and 12.5 percent, respectively. Individually, alcohol, tobacco products, and a number of illicit drugs (such as cocaine or amphetamine) are known to be harmful to the developing fetus during pregnancy. Determining the additional harm resulting from polydrug use during pregnancy is an exceptionally challenging task. The unpredictable interactive (either additive or synergistic) effects of the drugs used simultaneously have far-reaching implications on child health and development given the pervasive use of multiple drugs in our society.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):27-8.
• Article: Treating alcoholism as a chronic disease: approaches to long-term continuing care.

  James R McKay, Susanne Hiller-Sturmhofel
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  ABSTRACT: For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 33(4):356-70.
• Article: Behavioral therapy across the spectrum.

  Katie Witkiewitz, Alan Marlatt
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  ABSTRACT: Numerous effective behavioral therapies have been developed that can bring the treatment to the patient rather than bringing the patient to treatment. These behavioral therapy techniques, which can provide effective treatment across the spectrum of severity of alcohol abuse disorders, include facilitated self-change, individual therapies, couples and family approaches, and contingency management. New methods of delivery and successful adjuncts to existing behavioral treatments also have been introduced, including computerized cognitive-behavioral treatments, Web-based guided self-change, and mindfulness-based approaches. Although a wide variety of behavioral approaches have been shown to have good efficacy, choosing the treatment most appropriate for a given patient remains a challenge.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 33(4):313-9.
• Article: Integrating care for people with co-occurring alcohol and other drug, medical, and mental health conditions.

  Stacy Sterling, Felicia Chi, Agatha Hinman
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  ABSTRACT: Most people with alcohol and other drug (AOD) use disorders suffer from co-occurring disorders (CODs), including mental health and medical problems, which complicate treatment and may contribute to poorer outcomes. However, care for the patients' AOD, mental health, and medical problems primarily is provided in separate treatment systems, and integrated care addressing all of a patient's CODs in a coordinated fashion is the exception in most settings. A variety of barriers impede further integration of care for patients with CODs. These include differences in education and training of providers in the different fields, organizational factors, existing financing mechanisms, and the stigma still often associated with AOD use disorders and CODs. However, many programs are recognizing the disadvantages of separate treatment systems and are attempting to increase integrative approaches. Although few studies have been done in this field, findings suggest that patients receiving integrated treatment may have improved outcomes. However, the optimal degree of integration to ensure that patients with all types and degrees of severity of CODs receive appropriate care still remains to be determined, and barriers to the implementation of integrative models, such as one proposed by the Institute of Medicine, remain.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 33(4):338-49.
• Article: Maternal risk factors for fetal alcohol spectrum disorders: not as simple as it might seem.

  Philip A May, J Phillip Gossage
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  ABSTRACT: Gathering information about drinking during pregnancy is one of the most difficult aspects of studying fetal alcohol spectrum disorders (FASD). This information is critical to linking specific risk factors to any particular diagnosis within the FASD continuum. This article reviews highlights from the literature on maternal risk factors for FASD and illustrates that maternal risk is multidimensional, including factors related to quantity, frequency, and timing of alcohol exposure; maternal age; number of pregnancies; number of times the mother has given birth; the mother's body size; nutrition; socioeconomic status; metabolism; religion; spirituality; depression; other drug use; and social relationships. More research is needed to more clearly define what type of individual behavioral, physical, and genetic factors are most likely to lead to having children with FASD.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):15-26.
• Article: The quest for a neurobehavioral profile of heavy prenatal alcohol exposure.

  Sarah N Mattson, Edward P Riley
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  ABSTRACT: The devastating consequences of fetal alcohol syndrome (FAS) are well established, and, as a leading cause of intellectual disabilities (Pulsifer 1996), FAS has significant societal and public health implications. Importantly, FAS is associated with a broad range of neurobehavioral deficits (for more information, see the article by Coles, pp. 42-50 in this issue). However, FAS is only the most serious possible consequence of heavy prenatal alcohol exposure, and many individuals who do not meet diagnostic criteria for FAS also are severely impacted by gestational alcohol exposure. The term fetal alcohol spectrum disorders (FASD) is used to encompass a spectrum of effects that includes FAS towards the extreme end as well as conditions such as alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). The term ARND (Hoyme et al. 2005) refers to individuals who, after heavy prenatal alcohol exposure, exhibit neurobehavioral effects without meeting the physical criteria for FAS (for a review, see Vaurio et al. 2010). Clinical identification of this group of individuals is hampered precisely because they do not exhibit the external physical features of FAS, and the existing physiological biomarkers for gestational alcohol exposure have several limitations. Determination of a profile based on the neurobehavioral effects of heavy prenatal alcohol exposure would allow more accurate identification of affected individuals. To be clear, development of such a profile is aimed at identifying and characterizing those who are affected by prenatal alcohol exposure, not simply those who have been exposed to alcohol prenatally.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):51-5.
• Article: AN E-HEALTH SOLUTION FOR PEOPLE WITH ALCOHOL PROBLEMS.

  David H Gustafson, Michael G Boyle, Bret R Shaw, Andrew Isham, Fiona McTavish, Stephanie Richards, Christopher Schubert, Michael Levy, Kim Johnson
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  ABSTRACT: Self-management of chronic diseases has been a research focus for years. Information and communication technologies (ICTs) have played a significant role in aiding patients and their families with that management task. The recent dramatic increase in smartphone capabilities has expanded the potential of these technologies by facilitating the integration of features specific to cell phones with advanced capabilities that extend the reach of what type of information can be assessed and which services can be provided. A recent review of the literature covering the use of ICTs in managing chronic diseases, including addiction, has examined the effectiveness of ICTs, with an emphasis on technologies tested in randomized controlled trials. One example of an addiction-relapse prevention system currently being tested is the Alcohol Comprehensive Health Enhancement Support System (A-CHESS) Program.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 33(4):327-337.
• Article: Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome.

  Beth A Bailey, Robert J Sokol
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  ABSTRACT: In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):86-91.
• Article: School-based programs to prevent and reduce alcohol use among youth.

  Melissa H Stigler, Emily Neusel, Cheryl L Perry
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  ABSTRACT: Schools are an important setting for interventions aimed at preventing alcohol use and abuse among adolescents. A range of school-based interventions have been developed to prevent or delay the onset of alcohol use, most of which are targeted to middle-school students. Most of these interventions seek to reduce risk factors for alcohol use at the individual level, whereas other interventions also address social and/or environmental risk factors. Not all interventions that have been developed and implemented have been found to be effective. In-depth analyses have indicated that to be most effective, interventions should be theory driven, address social norms around alcohol use, build personal and social skills helping students resist pressure to use alcohol, involve interactive teaching approaches, use peer leaders, integrate other segments of the population into the program, be delivered over several sessions and years, provide training and support to facilitators, and be culturally and developmentally appropriate. Additional research is needed to develop interventions for elementary-school and high-school students and for special populations.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(2):157-62.
• Article: The risks associated with alcohol use and alcoholism.

  Jürgen Rehm
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  ABSTRACT: Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(2):135-43.
• Article: Translating family-focused prevention science into public health impact.

  Richard L Spoth, Lisa L Schainker, Susanne Hiller-Sturmhöefel
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  ABSTRACT: Underage drinking is a pervasive problem in the United States, with serious consequences for youth, families, communities, and society as a whole. Family-focused preventive interventions for children and adolescents have shown potential for reducing underage drinking and other problem behaviors. Research findings indicate that clear advances have been made, in terms of both the number of evidence-based interventions available, and in the quality of the methods used to evaluate them. To fully reap the benefits of such preventive interventions and achieve public health impact, the findings of family-focused preventive intervention science must be translated into real-world, community practices. This type of translation can be enhanced through four sets of translational impact factors-effectiveness of interventions, extensiveness of their population coverage, efficiency of interventions, and engagement of eligible populations, with sustained quality intervention implementation. Findings from studies conducted by researchers at the Partnerships in Prevention Science Institute and other empirical work highlight the importance of these factors. A model for community- university partnerships has been developed that potentially can facilitate the dissemination and public health impact of universal interventions to prevent underage drinking and other problem behaviors. This model fits well within a comprehensive strategic framework for promoting effective prevention.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(2):188-203.
• Article: Medications for unhealthy alcohol use: across the spectrum.

  Stephanie S O'Malley, Patrick G O'Connor
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  ABSTRACT: The prevalence of unidentified or untreated unhealthy alcohol use remains high. With the advent of pharmacotherapy and models of counseling appropriate for use in primary care settings as well as in specialty care, clinicians have new tools to manage the range of alcohol problems across the spectrum of health care settings. By extending treatment to primary care, many people who do not currently receive specialty care may have increased access to treatment. In addition, primary care providers, by virtue of their ongoing relationship with patients, may be able to provide continuing treatment over time. Extending the spectrum of care to hazardous drinkers who may not be alcohol dependent could result in earlier intervention and reduce the consequences of excessive drinking.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 33(4):300-12.
• Article: Focus on: the use of animal models for the study of fetal alcohol spectrum disorders.

  Shannon E Wilson, Timothy A Cudd
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  ABSTRACT: Considerable efforts to educate women not to abuse alcohol during pregnancy have failed to reduce the incidence of fetal alcohol syndrome. Therefore, other approaches to limit the effects of prenatal alcohol exposure are under consideration, including the development of prevention programs and interventions. For these strategies to be as successful as possible, it also is important to improve methods for identifying affected children. The use of animal models in prenatal alcohol exposure research is critical because of the practical and ethical limitations of using human subjects for such studies. This article reviews the use of animal models in three areas of research: addressing basic questions about alcohol exposure during development; improving the identification of affected individuals; and developing approaches to reduce the impact of prenatal alcohol exposure. The various animal-model systems that have been used to study fetal alcohol spectrum disorders, each with their own specific strengths, have provided new findings that have been successfully extrapolated to human subjects, resulting in advancement of the research field and our understanding of fetal alcohol spectrum disorders.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):92-8.
• Article: Focus on: epigenetics and fetal alcohol spectrum disorders.

  Michael S Kobor, Joanne Weinberg
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  ABSTRACT: Epigenetic changes-stable but potentially reversible alterations in a cell's genetic information that result in changes in gene expression but do not involve changes in the underlying DNA sequence-may mediate some of the detrimental effects of prenatal alcohol exposure and contribute to the deficits and abnormalities associated with fetal alcohol spectrum disorders. These epigenetic processes are linked to the chromatin (i.e., DNA, histone proteins, and other associated proteins) and commonly involve chemical modifications (e.g., methylation) of these molecules, which may result in altered expression of the affected genes. Even alcohol exposure prior to conception appears to be able to induce epigenetic changes in the parental genetic material that can be passed on to the offspring and affect offspring outcome. Similarly, epigenetic processes may occur as a result of maternal alcohol consumption during the period between fertilization of the egg and implantation in the uterus. The period most sensitive to alcohol's adverse effects appears to be gastrulation, which corresponds to prenatal weeks 3 to 8 in the human and prenatal days 7 to 14 in the mouse, when cells are differentiating to form organs. One way in which alcohol exposure may induce epigenetic changes, particularly abnormal DNA methylation, is by affecting a set of biochemical reactions called the methionine-homocysteine cycle.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):29-37.
• Article: Focus on: biomarkers of fetal alcohol exposure and fetal alcohol effects.

  Gyongyi Szabo, Ludmila N Bakhireva, Daniel D Savage
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  ABSTRACT: One of the ongoing challenges for the accurate diagnosis and treatment of children with fetal alcohol spectrum disorders (FASD) is the difficulty of confirming whether a mother drank during her pregnancy. Commonly used screening questionnaires often are unreliable, and current established biomarkers of alcohol consumption are not sensitive enough for use with many pregnant women. These limitations underscore the critical need to develop novel biomarkers with greater sensitivity for detecting moderate levels of drinking during pregnancy for longer periods of time after the last drinking episode. In addition, developing reliable biomarkers of fetal alcohol effects that can identify children at risk for adverse neurobehavioral outcomes could lead to behavioral interventions earlier in development. The use of animal models of FASD in biomarker development could accelerate progress in this challenging field of research.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 34(1):56-63.
• Article: The community reinforcement approach: an update of the evidence.

  Robert J Meyers, Hendrik G Roozen, Jane Ellen Smith
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  ABSTRACT: The Community Reinforcement Approach (CRA), originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning, CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use. Consequently, practitioners encourage clients to become progressively involved in alternative non-substance-related pleasant social activities, and to work on enhancing the enjoyment they receive within the "community" of their family and job. Additionally, in the past 10-15 years, researchers have obtained scientific evidence for two off-shoots of CRA that are based on the same operant mechanism. The first variant is Adolescent Community Reinforcement Approach (A-CRA), which targets adolescents with substance use problems and their caregivers. The second approach, Community Reinforcement and Family Training (CRAFT), works through family members to engage treatment-refusing individuals into treatment. An overview of these treatments and their scientific backing is presented.
  Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 01/2011; 33(4):380-8.