“Research shows there is a spike in alcohol-related consequences that occur in the first few weeks of the semester, especially with college freshmen,” said Michael J. Cleveland, research associate at the Prevention Research Center and the Methodology Center. “If you can buffer that and get beyond that point and safely navigate through that passage, you reduce the risk of later problems occurring.”

The researchers tested two different methods of intervention on incoming freshmen — parent-based intervention and peer-based intervention. Cleveland and his colleagues found that students who were non-drinkers before starting college, and who received the parent-based intervention, were unlikely to escalate to heavy drinking when surveyed again during the fall semester of their first year.

Students who were heavy drinkers during the summer before college were more likely to transition out of that group if they received either parent-based intervention or peer-based intervention. However, if a heavy-drinker received both interventions, there was no enhanced effect.

Cleveland reported online in Psychology of Addictive Behaviors that 8 percent of the incoming freshmen were heavy drinkers the summer before starting college. The researchers surveyed the students again during the fall semester and found 28 percent of the freshmen now drank heavily.

The results of the study were based on a study of 1,275 high-risk matriculating college students originally conducted in 2006 by Rob Turrisi, professor of biobehavioral health. Turrisi and his colleagues randomly assigned students to one of four intervention groups — parent-based intervention only, peer-based intervention only, both parent- and peer-based intervention or no intervention — and then surveyed the students on their drinking behaviors the summer before they entered college and then again during their first fall semester.

The parent-based intervention involved parents receiving a 35-page handbook outlining how to discuss the issue of alcohol and how to relate to their college student. Parents were asked to fill out an evaluation of the booklet, which also served as a measure to determine how many parents read the material. All parents completed the evaluations.

For peer-based intervention, subjects met one-on-one with a trained peer facilitator once within the first two weeks on campus. The meetings were 45 to 60 minutes long and included “perceived and actual descriptive norms for drinking, drinking consequences, alcoholic caloric consumption and hours of exercise required to burn those calories,” the researchers report.

All students included in the survey were former high school athletes, chosen because this group is considered at high risk for heavy alcohol use and its consequences, which include risky sex, driving drunk and personal injury or death.

In the new investigation, Cleveland and his colleagues approached the study differently. Rather than focusing on average levels of drinking — peak blood alcohol content, drinks per weekend and drinks per week — Cleveland reanalyzed the data using a person-centered approach to determine students’ patterns of drinking as well as how the students responded to intervention. This allowed the researchers to examine how drinking patterns varied throughout the week as well as how the interventions could be linked to students’ transitions from one sub-group to another.

“We found four sub-groups of drinkers, which is an important advance to understanding different types of drinking that were present in this college sample,” said Cleveland.

The sub-groups included non-drinkers, who did not report drinking alcohol at all; weekend non-bingers, who tended to only consume alcohol socially on Fridays and Saturdays; weekend bingers, who were likely to report binge drinking and getting drunk in the past month on Fridays and Saturdays; and heavy drinkers, who reported drinking every day of the week, most notably Thursdays.

Although neither intervention strategy appeared to influence the weekend drinkers, whether bingers or non-bingers, the intervention effects on the nondrinkers and heavy drinkers were promising, said Cleveland.

“From here we may be able to tailor the intervention to different types of students, identifying those students who are at different types of risk,” said Cleveland. “By figuring out a way to match the intervention to the individual you can also maximize your resources for intervention.”

Cleveland is continuing this work by replicating the results among another sample of college students and is also using the same methods to study the drinking behaviors of young adults who are not attending college.

For every three months during the study, participants drank an average of 8 percent fewer drinks on their heaviest drinking days.

They also had fewer instances of delirium tremens, a life-threatening form of alcohol withdrawal.

The American Journal of Public Health published the findings Jan. 19.

Housing for chronically homeless people usually comes with many conditions, including abstinence from drugs and alcohol and compliance with psychiatric and substance abuse treatment. But such requirements can become barriers to staying in housing.

“These individuals have multiple medical, psychiatric and substance abuse problems, and housing that requires them to give up their belongings, adhere to curfews, stop drinking and commit to treatment all at once is setting them up to fail. The result is that we are relegating some of the most vulnerable people in our community to a life on the streets,” said Susan Collins, lead author and University of Washington research assistant professor of psychiatry and behavioral sciences.

Because they are unable to cope with the rules, they often do not qualify for housing or are asked to leave. Once back on the street, they cost taxpayers’ money through use of emergency room visits, shelter and sobering center stays, arrests and jail bookings.

In response, an approach called project-based Housing First has been developed by the Downtown Emergency Service Center, a Seattle-based housing agency. Project-based Housing First provides immediate, permanent and supportive housing to chronically homeless people within a single housing project. It is considered “low-barrier” because it removes some of the traditional barriers to housing, such as abstinence from alcohol.

The idea behind it is that if chronically homeless people are provided with stable, permanent housing, then their medical, psychiatric and substance abuse problems will become more manageable.

Downtown Emergency Service Center’s 1811 Eastlake housing project is the first project-based Housing First model in the United States to be scientifically studied. Residents agree to spend 30 percent of their income – if they have any – on rent, and in return they are provided with permanent housing and social services.

An earlier study published in the Journal of the American Medical Association found that, in its first year of operation, this housing project saved Seattle taxpayers more than $4 million in costs from publicly funded services. The new study shows that drinking also decreases.

“A lot of people believe in the ‘enabling hypothesis’ – that allowing homeless, alcohol-dependent individuals to drink in their homes will enable them to drink more, and their drinking will spiral out of control,” Collins said. “But instead what we found are across-the-board decreases in alcohol consumption and problems.”

Health also improved. Residents reporting recent bouts of delirium tremens dropped by more than half over the two-year study, from 65 percent to 23 percent.

In the study:

• 94 percent of the 95 participants were men and most were white (40 percent) or American Indian/Alaska Native (27 percent).
• The average number of drinks consumed on the heaviest drinking day of the month decreased from 40 to 26 across two years, a decrease of 35 percent.
• The median number of drinks, a more accurate view of drinking patterns for this study’s participants, showed a change from 20 to 12 drinks per typical drinking day – a 40 percent drop.
• By the end of one year, 80 percent of participants remained in the study. That was reduced to 79 percent after 18 months and 61 percent after two years. Severity of drinking and demographic variables were ruled out as reasons why participants left the study.

Collins said that she and her team witnessed the resilience of the residents. “When they were on the streets, they were in dire straits and did what they needed to do to survive,” Collins said. But with steady housing, they were able to have a more normal existence. “Participants in the study told us that they’re happy to have a home, and happy that they no longer have to drink to stay warm or to put themselves to sleep or to forget that they’re on the streets.”

People tend to think that chronically homeless people with severe alcohol problems are unable to control themselves or monitor their drinking, Collins said, but instead this study shows that they are “human beings who are capable of change if they are given the same chance as the rest of us.”

Results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“This study was designed to address two challenges in FAS studies,” said Haruna Sawada Feldman, a post-doctoral student in the department of pediatrics under the mentorship of professor Christina Chambers at the University of California, San Diego. “The first challenge concerned obtaining accurate alcohol exposure history from maternal reports that might involve social stigma and recall bias. This study collected information during pregnancy when women were unaware of their pregnancy outcome. The data were also collected by trained counseling specialists who had built a rapport with the woman and guaranteed confidentiality while collecting sensitive information. Finally, data were collected with specific details about timing in gestation, dose and pattern.”

The second challenge concerned the quality of information on specific physical features of FAS. “These alcohol-related features are often subtle, and a non-expert examiner may miss or misclassify features, and/or can be biased by subjectivity, especially if he/she suspects or knows about prenatal alcohol exposure (PAE),” said Feldman. “This study used an exposure-blinded expert dysmorphologist to look for these features. Furthermore, potential bias due to subjectivity was reduced because these examinations were conducted in the context of a larger study of more than 70 agents of interest, only one of which was alcohol.”

“Research that links the quantity, frequency and timing of alcohol consumption during pregnancy among humans is virtually non-existent,” added Philip A. May, a research professor in the Gillings School of Global Public Health at The University of North Carolina. “While animal data exist, studies like this one in humans are greatly needed, because extrapolation of concepts from animal models to humans is fraught with complications and problems of translation.”

Feldman and her colleagues used data gathered on 992 women and their singleton infants in California between 1978 and 2005, examining patterns of drinking and timing of alcohol exposure in relation to selected FAS features. Structural features were assessed by a dysmorphologist who performed a blinded physical examination of all infants. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated zero to six weeks post-conception, six to 12 weeks post-conception, and during the first, second, and third trimesters.

“Higher PAE in every pattern we examined was significantly associated with an increased risk for having an infant born with reduced birth length or weight or having a smooth philtrum or thin vermillion border or microcephaly,” said Feldman. “The most significant associations were seen during the second half of the first trimester; for every one drink increase in the average number of drinks consumed daily, there was a 25 percent increased risk for smooth philtrum, a 22 percent increased risk for thin vermillion border, a 12 percent increased risk for microcephaly, a 16 percent increased risk for reduced birth weight, and an 18 percent increased risk for reduced birth length.”

“This paper clearly illustrates that drinking alcohol, especially binge drinking, during the first seven to 12 weeks of gestation is associated with four of the most important facial features characteristic of FAS as well as reductions in birth length and weight that are also characteristic of infants and children with FAS,” said May. “This study also illustrates clearly that there is no threshold that triggers these features of FAS. Instead there is variability from woman to woman in the level of drinking that produces these features.”

Feldman added that the lack of associations found during first-half of the first trimester between alcohol and outcomes should not be interpreted to mean that alcohol consumption during this time period is somehow safe. “Due to the study design, we were only able to include women who gave birth to live infants,” she said. “Therefore, we did not include women who may have had miscarriages or stillbirths. It is important to know that alcohol-exposed infants who would have exhibited alcohol-related minor malformations might also be more likely to be lost to miscarriage following exposure during the first six-week window.”

Both Feldman and May believe these findings reinforce the warning that there is no “safe” level of alcohol consumption during pregnancy. “Clinicians should continue to follow the recommendations to encourage women who are planning a pregnancy or have the potential to become pregnant to avoid alcohol, and to advise women who become pregnant to stop alcohol consumption,” said Sawada. “These new findings can also help clinicians quantify the importance of discontinuing alcohol as early as possible.”

Results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“People in low to middle-income countries are experiencing a lot of stress due to rapid industrialization and urbanization and are therefore likely to use substances more to relieve their stress,” explained Hae Kook Lee, associate professor at the Catholic University of Korea and corresponding author for the study. “Furthermore, westernization might weaken the taboo for female drinking, especially in Eastern countries.”

“Cross-cultural epidemiologic studies like this one are extremely valuable,” added Howard B. Moss, associate director for clinical and translational research at NIAAA. “Despite over thirty years of research emphasizing the biopsychosocial nature of a wide variety of mental disorders, we see an over-emphasis of the neurobiological underpinnings of addictive disorders. Of course alcohol and other drugs of abuse do significantly impact upon brain processes through mechanisms of reward, plasticity, and adaptation leading from use, intoxication, and tolerance to physical dependence. However, the human process of addiction is much more complex than dopamine release in the reward pathways of the brain or the binding occupancy of the endogenous opiate receptors. Cross-cultural studies like this one reveal that we should also appreciate that the personal distress felt by addicted patients, and their frequently challenging illness behaviors, are manifestations of complex psychological processes that may be culturally bound and exist within a sociocultural paradigm. Thus, research like this reminds the scientific community of the complexity of alcoholism and comorbid conditions.”

Lee and his colleagues used nationally representative samples of the U.S. and South Korean general populations to compare rates of AUDs, ND, and mood and anxiety disorders between the two countries. Study authors also examined the rates and comorbidity patterns among individuals with AUDs who sought treatment in the preceding 12 months.

“Results showed that the prevalence of AUDs among Americans was substantially greater than among South Koreans,” said Lee. More specifically, the 12-month prevalences of AUDs, ND, and any mood and any anxiety disorders were 9.7, 14.4, 9.5 and 11.9 percent among Americans, compared to 7.1, 6.6, 2.0, and 5.2 percent among South Koreans. “The differences in overall prevalence of AUD rates between the two countries was largely due to prevalence among females, that is, drinking by women has historically been tempered by Confucian culture in Korea even though it is increasing rapidly now.”

“America has a longer cultural history with alcohol than do South Koreans,” added Moss. “At the time of the colonization of North America, most European colonists came from countries with strong cultural ties to regular and heavy alcohol consumption. While the Korean people historically used alcohol, its use was limited during the colonial period. Alcohol use was then stimulated in 1986 by a government policy to identify and support culturally important Korean alcoholic beverages. While Prohibition, in theory, limited American access to legal drinking for 13 years, Americans did not have a prolonged abstinence period that shifted cultural norms as occurred in Korea.”

“Even though we found a greater prevalence of alcoholism, mood and anxiety disorders among Americans in comparison to South Koreans,” said Lee, “alcohol-dependent Americans were four times more likely to seek treatment compared to their Korean counterparts, which may indicate the influence of a social stigma toward substance-abuse or mental-health problems despite national health insurance in Korea.”

While Moss agreed that it is clear that South Koreans are less likely to seek treatment for their alcohol problems than Americans, he questioned that this is because of stigma and saving face. “Americans with alcohol dependence and psychiatric comorbidity are more likely to seek treatment than those with alcohol dependence alone,” he observed. “I think seeking treatment has more to do with the degree of discomfort and suffering experienced by the individual, perhaps combined with issues of stigma and face-saving.”

Another finding, comorbidity of mood and anxiety disorders and alcohol use disorders, is the norm rather than the exception, added Lee. “These patterns were similar among American and Korean alcoholics,” he said. “Further, socio-cultural factors might also affect treatment seeking and rates of comorbidity as the higher social stigma of psychiatric treatment might make the patients with mood disorders drink more to relieve their symptoms.”

However, added Moss, the patterns of comorbid psychiatric disorders were different among Korean smokers versus American smokers as American smokers displayed more comorbid mood and anxiety disorders than did Korean smokers.

“Fundamentally,” said Moss, “I think this study forces us to think more about cultural and environmental influences on the etiology of alcohol dependence in conjunction with the neurobiology and genetics of addiction. This study reminds us that neither biological determinism nor social determinism is the whole story. Human behavior is extremely complex, and reductionism of any sort is, more often than not, incorrect.”

Results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“We know that a familial history of alcoholism is a significant risk factor for future alcohol abuse,” said Bonnie J. Nagel, assistant professor of psychiatry and behavioral neuroscience at Oregon Health & Science University as well as corresponding author for the study. “We were interested in determining whether adolescents at heightened risk for alcohol use made more risky decisions during a laboratory task compared to their lower-risk peers. Additionally, we wanted to examine whether differences in brain responses when making risky decisions were present in these two groups. We wanted to investigate pre-morbid neural risk factors during decision making in FHP youth, as opposed to differences in brain response due to heavy alcohol use itself.”

“This is the first study to examine the neural substrates of risk-taking in FHP adolescents who are substance naïve,” added Megan Herting, a PhD candidate in behavioral neuroscience at Oregon Health & Science University. “A previous study looked at young adults who were drinkers, therefore, it is hard to say if the differences found were purely a pre-existing neural risk factor for alcohol use. Alcohol use may also differentially impact the brains of those with and without a family history of alcoholism. Thus, the current study is a very novel and important piece of work showing that the brain is doing something different during risky decision making in substance-naïve FHP adolescents.”

Study authors recruited 31 youth – 18 FHP (12 males, 6 females) and 13 FHN (8 males, 5 females) – between 13 and 15 years of age from the local community. All of the youth had little to no alcohol involvement prior to their participation in the study. Functional magnetic resonance imaging (fMRI) was used to examine brain responses of the youth during a Wheel of Fortune (WOF) decision-making task, which presented risky versus safe probabilities of winning different amounts of money.

“While our study found that FHP adolescents did not perform significantly differently on the WOF task compared to the FHN adolescents,” said Nagel, “we found two areas of the brain that responded differently. These areas were in the prefrontal cortex and cerebellum, both of which are important for higher-order day-to-day functioning, such as decision-making. In these brain regions, FHP adolescents showed weaker brain responses during risky decision-making compared to their FHN peers. We believe that weaker activation of these brain areas, known to be important for optimal decision-making, may confer vulnerability towards risky decisions with regards to future alcohol use in adolescents already at risk for alcoholism.”

Herting noted that higher-order or executive functioning is also important for things like attention, working memory, and inhibition. “Therefore, differences in brain activity may impact the ability of FHP individuals to make good decisions in many contexts, and in particular may facilitate poor decision-making in regards to alcohol use,” she said. “Taken together with other studies on FHP youth, these results suggest that atypical brain structure and function exist prior to any substance use, and may contribute to an increased vulnerability for alcoholism in these individuals.”

Both Nagel and Herting believe these findings can help to develop better prevention programs based on familial risk factors. “These findings may suggest a neurobiological marker that helps to explain how family history of alcoholism confers risk,” said Nagel. “Furthermore, our research may aid clinicians who work with high-risk youth to develop effective prevention strategies for these adolescents to promote healthy decision-making.”

However, they both added, having a familial history of alcoholism is just one of many different factors involved in future alcohol abuse. “While having a family history of alcoholism may put one at greater risk for alcohol abuse, personality and behavioral risk factors are also important to consider,” said Nagel. “The combination of genetic and environmental factors is very different for everyone, so some individuals may be at higher risk than others, and certainly there are genetic and environmental factors that can also protect against alcohol abuse. Future research will need to determine the relative influence of these traits on alcohol abuse risk to be able to design specific prevention strategies for different high-risk populations.”

The finding marks the first time that endorphin release in the nucleus accumbens and orbitofrontal cortex in response to alcohol consumption has been directly observed in humans.

Endorphins are small proteins with opiate-like effects that are produced naturally in the brain.

“This is something that we’ve speculated about for 30 years, based on animal studies, but haven’t observed in humans until now,” said lead author Jennifer Mitchell, PhD, clinical project director at the Gallo Center and an adjunct assistant professor of neurology at UCSF. “It provides the first direct evidence of how alcohol makes people feel good.”

The discovery of the precise locations in the brain where endorphins are released provides a possible target for the development of more effective drugs for the treatment of alcohol abuse, said senior author Howard L. Fields, MD, PhD, a professor of neurology and Endowed Chair in Pharmacology of Addiction in Neurology at UCSF and director of human clinical research at the Gallo Center.

The study appears on January 11, 2012, in Science Translational Medicine.

The researchers used positron emission tomography, or PET imaging, to observe the immediate effects of alcohol in the brains of 13 heavy drinkers and 12 matched “control” subjects who were not heavy drinkers.

In all of the subjects, alcohol intake led to a release of endorphins. And, in all of the subjects, the more endorphins released in the nucleus accumbens, the greater the feelings of pleasure reported by each drinker.

In addition, the more endorphins released in the orbitofrontal cortex, the greater the feelings of intoxication in the heavy drinkers, but not in the control subjects.

“This indicates that the brains of heavy or problem drinkers are changed in a way that makes them more likely to find alcohol pleasant, and may be a clue to how problem drinking develops in the first place,” said Mitchell. “That greater feeling of reward might cause them to drink too much.”

Before drinking, the subjects were given injections of radioactively tagged carfentanil, an opiate-like drug that selectively binds to sites in the brain called opioid receptors, where endorphins also bind. As the radioactive carfentanil was bound and emitted radiation, the receptor sites “lit up” on PET imaging, allowing the researchers to map their exact locations.

The subjects were then each given a drink of alcohol, followed by a second injection of radioactive carfentanil, and scanned again with PET imaging. As the natural endorphins released by drinking were bound to the opioid receptor sites, they prevented the carfentanil from being bound. By comparing areas of radioactivity in the first and second PET images, the researchers were able to map the exact locations — areas of lower radioactivity — where endorphins were released in response to drinking.

The researchers found that endorphins released in response to drinking bind to a specific type of opioid receptor, the Mu receptor.

This result suggests a possible approach to improving the efficacy of treatment for alcohol abuse through the design of better medications than naltrexone, said Fields, who collaborated with Mitchell in the design and analysis of the study.

Fields explained that naltrexone, which prevents binding at opioid receptor sites, is not widely accepted as a treatment for alcohol dependence — “not because it isn’t effective at reducing drinking, but because some people stop taking it because they don’t like the way it makes them feel,” he said.

“Naltrexone blocks more than one opioid receptor, and we need to know which blocking action reduces drinking and which causes the unwanted side effects,” he said. “If we better understand how endorphins control drinking, we will have a better chance of creating more targeted therapies for substance addiction. This paper is a significant step in that direction because it specifically implicates the Mu opioid receptor in alcohol reward in humans.”

But people without that trait don’t get any more aggressive when drunk than they would when they’re sober.

That trait is the ability to consider the future consequences of current actions.

“People who focus on the here and now, without thinking about the impact on the future, are more aggressive than others when they are sober, but the effect is magnified greatly when they’re drunk,” said Brad Bushman, lead author of the study and professor of communication and psychology at Ohio State University.

“If you carefully consider the consequences of your actions, it is unlikely getting drunk is going to make you any more aggressive than you usually are.”

Peter Giancola, professor of psychology, at the University of Kentucky, co-authored the paper with Bushman and led the experiments used in the study.  Other co-authors were Dominic Parrott, associate professor of psychology at of Georgia State University and Robert Roth, associate professor of psychiatry, at Dartmouth Medical School.  Their results appear online in the Journal of Experimental Social Psychology and will be published in a future print edition.

Bushman said it makes sense that alcohol would make present-focused people more aggressive.

“Alcohol has a myopic effect — it narrows your attention to what is important to you right now.  That may be dangerous to someone who already has that tendency to ignore the future consequences of their actions and who is placed in a hostile situation.”

The study involved 495 adults, with an average age of 23, who were social drinkers.  Before participating, the participants were screened for any past or present drug, alcohol and psychiatric-related problems.  Women were tested to ensure they weren’t pregnant.

All participants completed the “Consideration of Future Consequences scale.”  They indicated how much they agreed with statements like “I only act to satisfy immediate concerns, figuring the future will take care of itself.”  Scores on this measure determined how much participants were present-focused or future-focused.

Half the participants were put in the alcohol group, where they received alcohol mixed with orange juice at a 1:5 ratio.  The other half were given orange juice with just a tiny bit of alcohol.  The rims of the glasses were also sprayed with alcohol so that they thought they were consuming a full alcoholic beverage.

Participants in the alcohol group had a mean blood alcohol level of 0.095 just before aggression was measured and 0.105 following, meaning they were legally drunk and that their alcohol levels were rising during the measurement of their aggressive behavior.

Those in the placebo group had mean blood alcohol levels that didn’t exceed 0.015, meaning they had very little alcohol in their systems and were well below standards of intoxication.

The aggression measure used in this study was developed in 1967 to test aggressiveness through the use of harmless but somewhat painful electric shocks.  The researchers measured the participants’ threshold to the electric shock pain before the experiment began to ensure that no one received a shock that exceeded what they could take.

Each of the participants was told that he or she was competing with a same-sex opponent in a computer-based speed reaction test, with the winner delivering an electrical shock to the loser.  The winner determined the intensity and the length of the shock delivered to the loser.

In actuality, there was no opponent.  There were 34 trials, and the participant “won” half of them (randomly determined).  Each time they “lost,” the participants received electric shocks that increased in length and intensity over the course of the trials, and the researchers measured if they retaliated in kind.

“The participants were led to believe they were dealing with a real jerk who got more and more nasty as the experiment continued,” Bushman said.  “We tried to mimic what happens in real life, in that the aggression escalated as time went on.”

Results were clear, Bushman said.

“The less people thought about the future, the more likely they were to retaliate, but especially when they were drunk.  People who were present-focused and drunk shocked their opponents longer and harder than anyone else in the study,” he said.

“Alcohol didn’t have much effect on the aggressiveness of people who were future-focused.”

Men were more aggressive than women overall, but the effects of alcohol and personality were similar in both sexes.  In other words, women who were present-focused were still much more aggressive when drunk than were women who were future-focused, just like men.

Bushman said the results should serve as a warning to people who live only in the moment without thinking too much about the future.

“If you’re that kind of person, you really should watch your drinking.  Combining alcohol with a focus on the present can be a recipe for disaster.”

The study was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and from the National Center for Research Resources.

Results will be published in the March 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“This issue is extremely important because adolescents who are criminally active are significantly more likely to be adult criminals,” said Michael T. French, professor of health economics at the University of Miami and corresponding author for the study. “Although adolescents often commit less serious crimes than adults – for example, vandalism and shoplifting – these behaviors can quickly escalate into a criminally active lifestyle without effective interventions. Understanding how alcohol use among adolescents may contribute to criminal activity is therefore a logical and policy relevant area for research.”

Unfortunately, French added, much of the research has focused only on illicit drugs and criminal activity. Second, quality data are hard to come by. The health survey data set used in this study, he said, is one of the few longitudinal datasets with excellent measures for alcohol use and criminal activity.

He and his colleagues used data from four waves (n=20,746; n=14,738; n=15,190; n=9,576) of the National Longitudinal Study of Adolescent Health to examine alcohol-use patterns and criminal activity from adolescence through to young adulthood. They were interested in several questions: Does alcohol use have different effects on being a victim or being a perpetrator of a crime? Is the likelihood of committing a property crime for drinkers relative to non-drinkers greater than that of being involved in other types of crime? How do these relationships differ for males and females? Are frequent binge drinkers more likely to be involved in criminal activity compared to occasional drinkers or abstainers?

“We found that for both adolescent males and females, more frequent alcohol consumption is associated with a greater probability of committing a property crime, committing a predatory crime, and being a victim of a predatory crime,” said French. “While we were not necessarily surprised that these relationships existed for both genders, the strength of the relationships was a bit unexpected as well as the fact that they were robust to numerous sensitivity tests.”

The key message, he noted, is that frequent alcohol use by adolescents may be as important a risk factor for criminal activity as illicit drug use. “Educators, parents, clinicians, and others who interact with adolescents can use these findings as an incentive to be vigilant about underage alcohol use as this behavior could be linked with current criminal activities or a least a precursor to future illegal acts,” he said. “Early intervention is probably the best defense in this case.”

However, French cautioned, while these findings may inform public-policy measures designed to reduce drinking among adolescents with the goal of reducing criminal activity and delinquency, it would be incorrect and misguided to conclude from these findings that all frequent-drinking adolescents are associated with criminal acts, either as a perpetrator or victim. “However,” he said, “this study demonstrates that frequent alcohol consumption is an important risk factor that should not be easily dismissed as normal adolescent behavior.”

Results will be published in the March 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Each day in the U.S., more than 50,000 adults 18 to 24 years of age visit hospital EDs, and more than one third report current alcohol abuse or dependence,” said Brian Suffoletto, assistant professor in the department of emergency medicine at the University of Pittsburgh and corresponding author for the study. “Thus, EDs provide a unique opportunity to both identify young adults with harmful or hazardous drinking behavior and intervene to reduce future injury and illness.”

Unfortunately, he added, emergency-care providers rarely have the time or expertise to screen for or discuss problematic alcohol use. Nor do many hospitals have counselors on staff who can assist with the process. Neither are patients with acute drinking issues necessarily interested in having those discussions immediately.

“Given that mobile phones are essentially ubiquitous among young adults, and texting in particular is a heavily used communication tool, we sought to build and test an automated TM system that could conduct a health dialogue with young adults after discharge,” said Suffoletto. “We believe that our study is the first to test a TM-based behavioral intervention to reduce alcohol consumption.”

“This is a novel approach in that it uses the ED as a behavior-changing point for those at risk for a illness – alcohol-induced injury or organ destruction – while using a familiar but not deployed alternative approach, which is texting,” said Donald M. Yealy, professor of emergency medicine, medicine, and clinical and translational sciences at the University of Pittsburgh School of Medicine. “This is a first step. I can envision other tools – such as phone apps and social media sites – being deployed eventually.”

Suffoletto and his colleagues identified 45 18-to-24-year olds (24 women, 21 men) from three urban EDs as hazardous drinkers based on their Alcohol Use Disorders Identification Test-Consumption scores. The young adults were randomly assigned for a 12-week period to either weekly TM feedback with goal setting (Intervention), weekly TM drinking assessments without feedback (Assessment), or the Control group.

“First, we were able to show that young adults will interact with an automated TM system to both provide weekly drinking reports and respond to goal-setting challenges,” said Suffoletto. “Second, our preliminary findings suggest that young adults who are exposed to our intervention reduce the number of drinks they consume as well as the number of binge episodes.” More specifically, at the end of the three-month period, participants in the TM group had 3.4 fewer heavy drinking days in the preceding month, and 2.1 fewer drinks per drinking day when compared to baseline.

Suffoletto suggested that emergency clinicians use these results to “rethink” the use of alternative interventions, such as TM, to reach young adults after they are discharged from the ED. “Our study findings are preliminary, yet encouraging, evidence that ecological assessments tied to real-time feedback using mobile communication technology can affect change in young adults with harmful or hazardous drinking behavior,” he said. “Future work should focus on ways to optimize patient participation in programs and the integration of mobile communication with traditional interventions.”

Both Suffoletto and Yealy see additional uses for these findings.

“Clinicians who care for young adults and adolescents in other care settings may [also] decide to use mobile technologies to support and extend already existing resources to reduce the burden of alcohol use and alcohol-related risks,” said Suffoletto. “Researchers interested in behavior change [for other] substance-use disorders may decide to build and test similar behavioral interventions using mobile communication devices, such as apps, to affect change.”

“I could envision beginning such a program in other populations – like those with heart failure, or high blood pressure, or an infection – to aid compliance with agreed-on plans,” added Yealy.

“The average person who either is struggling with an alcohol-use disorder or knows someone who is might be encouraged to know that researchers are exploring non-traditional approaches to supporting self-change,” said Suffoletto, “and finding ways that make it easier for an individual to get help.

Unsafe sex is the most important pathway to HIV infection, and it is a main risk factor for the global burden of disease. Despite this knowledge, and substantial efforts to prevent unsafe sex, HIV incidence in most high income countries (such as the US or the UK) has not changed over the past decade. In some cases, it has even increased. Finding better ways to prevent unsafe sex is thus a major goal of public health efforts for HIV/AIDS prevention.

Alcohol consumption, especially heavy drinking, has long been associated with HIV incidence. However, there have been doubts about the cause-and-effect relationship. Researchers weren’t sure if alcohol consumption caused HIV via unsafe sex, or whether certain personality traits in individuals, such as sensation-seeking or a disposition to risky behaviour in general, would lead to both alcohol use and unsafe sex.

The study, published in the January issue of the journal Addiction, summarizes the results of 12 experiments that tested this cause-and-effect relationship in a systematic way. After pooling the results, the researchers found that alcohol consumption affects decision-making, and that this impact rises with the amount of alcohol consumed. The more alcohol that participants consumed, the higher their willingness to engage in unsafe sex.

In these experiments, study participants were randomly allocated to one of two groups in which they either consumed alcohol or did not. Then their intention to engage in unsafe sex was measured. An increase in blood alcohol level of 0.1 mg/mL resulted in an increase of 5.0% (95% CI: 2.8% – 7.1%) in the indicated likelihood of engaging in unprotected sex. This result remained stable in sensitivity analyses aimed to correct for a potential publication bias.

“Drinking has a causal effect on the likelihood to engage in unsafe sex, and thus should be included as a major factor in preventive efforts for HIV”, commented Dr. J. Rehm, the Principal Investigator of the study. “This result also helps explain why people at risk often show this behaviour despite better knowledge: alcohol is influencing their decision processes.”

Future HIV/AIDS prevention programs should include the results of this study. For instance, efforts to reduce drinking, and especially to reduce heavy drinking occasions, will not only avoid compromising the immune system but will also lower the chance of engaging in unsafe sex, thereby reducing the number of new HIV infections.