Alcohol Help

A study involving approximately 1,900 14-year-olds found that differences in adolescents’ brain activity may put some at higher risk for drug and alcohol experimentation than others, even they are exposed to drugs or alcohol.

In that Nature Neuroscience study (subscription required), researchers examined data from an ongoing study of European teens where participants completed behavior testing and underwent magnetic resonance imaging. Participants were also asked about symptoms of attention deficit hyperactivity disorder and if they had tried alcohol, cigarettes or other drugs. ABC News reports:

# Interestingly, [researchers] were able to identify teens who had prior exposure to alcohol, nicotine, or other illicit drugs and were able to identify specific brain patterns associated with early experimentation with these substances. Furthermore, teens with poor impulse control but no prior substance use had brain images similar to those who had already admitted use.

# The findings suggest that there may be an opportunity to identify teens at risk before they indulge. “While identifying those at greatest risk of addiction is a complex process with many different factors involved, identifying brain networks specific to impulse control represents the first step” says [lead researcher Robert Whelan, PhD.]

# In agreement with prior studies, both adolescents with a history of ADHD or a history of alcohol or drug use had poor impulse control scores. But researchers found that the brain networks activated in teens with ADHD were different than the ones associated with early drug use.

# “This suggests that these two conditions may be unnecessarily tightly coupled together,” says Whelan. This knowledge may help guide doctors’ treatment strategies.

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There is a growing concern about, and emphasis on, healthy lifestyles. Weighing the benefits and risks of alcohol consumption should find a place in every lifestyle assessment, a recommendation encouraged by the Center for Drug and Alcohol Programs.

Alcohol has been around for thousands of years. The Bible makes frequent reference to wine being the centerpiece of many religious rites and rituals for ages. Beer was the preferred safe beverage during the Middle Ages when water lacked purity and could cause disease. In Western societies in general, and in the United States in particular, alcohol is part of the cultural fabric. It is a social lubricant and enjoyed by many, with 90 percent of all Americans having had at least one alcohol drink in their lifetime.

Luckily, for those who are moderate social drinkers, men who drink less than 14 drinks a week and no more than two drinks a day, or those women drinking less than seven drinks per week or no more than one per day, alcohol has considerable health benefits. A standard drink is 1.5 oz. of liquor, 12 oz. of beer, or 5 oz. of wine. At these drinking levels, alcohol is known to reduce heart attacks, increase good cholesterol, have a mild anti-clotting effect and might even reduce the risk of dementia. However, as drinks per day increase above these limits, there are increasing negative health consequences.

For instance, it is well documented that drinking more than two drinks per day for men and one for women will elevate blood pressure and at four to five drinks per day for men and three to four drinks for women, the odds of having high blood pressure are substantially increased. It is not widely appreciated that heavy alcohol consumption is the number one leading preventable cause of hypertension.

Many heavier drinkers take antihypertensive medications when a reduction of alcohol consumption might do just as well to lower blood pressure.

At these drinking levels there is a significantly increased risk of heart attack, stroke, and many forms of cancer. For instance, for women receiving hormone replacement and who drink seven to 14 drinks a week, the risk of developing breast cancer goes up tenfold.

For the 7 percent of Americans (14 million adults) who have genetic risk or stress-induced heavy alcohol consumption that leads to life problems (alcohol abuse or dependence) additional problems may occur. For instance, those who drink more than six drinks a day might have problems with memory, concentration and sleep. They accomplish less, might withdraw from social and family activities, and put themselves and others at risk from accidents, such as fires, auto accidents and falls. It is known that about half of all trauma admissions to hospitals involve heavy alcohol use.

The elderly, who already have reduced balance and coordination problems, are more sensitive to alcohol, leading to a higher risk for falls. Since heavy alcohol use can also lead to osteoporosis (softening of bones), the falls can easily cause broken hips, wrists, ribs and vertebrae, as well as head trauma – thereby creating a double health risk. Since alcohol can interact negatively with many medications, these risks are even higher in senior citizens since they are taking more and varied medications.

The good news is that treatments to assist individuals curtail, or stop, their alcohol use are available and new ones are being discovered more frequently at MUSC and at other major alcohol research centers in the country.

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Up to half of the people who are treated at hospital emergency departments and trauma centers are under the influence of alcohol, experts say. That may be a sobering statistic, yet a recent study found that emergency departments can capitalize on this “teachable moment” to discourage problem drinking in the future.

But laws in more than half the states permit insurers to deny payment for medical services related to alcohol or drug use and that can derail hospitals’ best intentions, experts say. Faced with the prospect of not getting paid for care, some emergency department personnel may sidestep the problem by simply not testing patients’ blood or urine for alcohol.
More From This Series Insuring Your Health

In the study, published online in the Annals of Emergency Medicine in March, nearly 600 emergency department patients who were identified as hazardous or harmful drinkers (defined for men as drinking more than 14 drinks per week or more than four on any single occasion, and for women as more than seven weekly drinks or three on any one occasion) took part in a seven-minute interview. During the interview, an emergency department staff member discussed the link between a patient’s injuries and alcohol, as well as guidelines for low-risk drinking, and encouraged the patient to discuss what was stopping him from drinking less and to set a drinking goal.

Compared with those who received standard care, patients who took part in the sessions reduced their average number of weekly drinks significantly as well as their episodes of binge drinking and drinking and driving over the next 12 months.

“In the emergency department on a weekend, all the cases may be drug or alcohol related, and yet we don’t do” screening and intervention, says Gail D’Onofrio, the study’s lead author who is chair of emergency medicine at Yale University School of Medicine. “Our goal is to normalize this in the emergency department.”

Although some of the nearly 4,000 emergency departments screen patients for drug or alcohol use, it’s not required. Level 1 and 2 trauma centers, however, which are typically equipped to handle emergency patients suffering from serious injuries sustained, for example, in major car accidents, must screen for problem drinkers. Level 1 trauma centers must also be able to provide counseling.

Such screening and counseling can be effective, says Larry Gentilello, a trauma surgeon who has published studies on injury prevention and substance abuse.

“Most of the people who are injured don’t need to go into treatment,” he says. “They aren’t alcoholics or alcohol dependent. That’s why one counseling session can help them by talking about the risks of drinking.”

The extent to which so-called alcohol-exclusion laws deter emergency medical personnel from screening and counseling patients for alcohol or drugs is unknown.

The laws have a long history. Since 1947, more than 40 states have passed measures allowing health plans to refuse to pay for care if the patient’s injuries occurred while he was under the influence of alcohol or, in some states, drugs, say experts. As people came to understand alcohol addiction and the possibility of treatment, however, it became clear that the laws were counterproductive. In 2001, the National Association of Insurance Commissioners recommended against them.

Since then, at least 15 states have repealed or amended their laws and now prohibit exclusions of coverage for drinking or drugs, according to data from the National Institute on Alcohol Abuse and Alcoholism. Maryland and the District of Columbia are among them; Virginia’s law remains in place.

Regardless of state law, self-insured companies that pay their employees’ health care costs directly can refuse to cover employees for alcohol-related claims.

The laws have ensnared both problem and occasional drinkers.

Gentilello describes the case of a Seattle woman who was celebrating her 25th wedding anniversary and had a few glasses of champagne at dinner with her family. It was a rainy night and she was dressed up and wearing high heels. As she and her husband tried to hail a cab, she tripped on a curb, fell and broke her ankle. In the emergency department, her chart noted that she had a few drinks. Her insurer refused to pay. Washington subsequently adopted a prohibition on alcohol-related claims exclusions in 2004.

It’s unclear how frequently insurers continue to apply such laws to avoid paying claims. Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade organization, says the group doesn’t know what member practice is. Cynthia Michener, a spokeswoman for Aetna, says that “to our knowledge” the company doesn’t apply such exclusions. Other insurers, including UnitedHealthcare and Humana, didn’t provide information about their practices.

But a professor who has written about such laws says there are indications that health plans continue to use them to deny payment.

“There are tons of these cases,” says Sara Rosenbaum, a professor of health law and policy at George Washington University’s School of Public Health and Health Services. “The only evidence we have suggests that these cases go on.”

“There’s no reason to think that insurers, eager to hold down costs, wouldn’t continue” to deny payment based on such exclusions, she adds.

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A research team this week will present findings that they say may finally explain the link between alcohol consumption and breast cancer.

“Cells have different mechanisms to remove toxic substances, such as ethanol, the chemical name for alcohol, that represent a potential risk to them,” explains Maria de Lourdes Rodriguez-Fragoso, professor of pharmacology and toxicology at the Universidad Autonoma del Estado de Morelos in Mexico. “Unfortunately, sometimes these mechanisms produce other toxic substances, including some that are associated with the development of different types of cancer.”

At 12:25 p.m. Monday, April 23, Rodriguez-Fragoso will present her group’s work at the annual meeting of the American Society for Biochemistry and Molecular Biology, held in conjunction with the Experimental Biology 2012 conference in San Diego.

Alcohol consumption has long been established as a risk factor for breast cancer. But finding the direct link that makes it so has, so far, proved elusive. Now, Rodriguez-Fragoso and her collaborators think that they have found the answer, a protein called CYP2E1.

“We knew that CYP2E1 could break down ethanol and that doing so created unstable, highly reactive chemicals known as free radicals,” she says. Working with researcher Scott Burchiel and his group at the University of New Mexico, Rodriguez-Fragoso’s team had previously found that free radicals were associated with activation of cellular mechanisms that lead to tumor development. “The question then was, does having more CYP2E1 make you more susceptible to ethanol-induced toxicity, thereby increasing your risk of developing cancer?”

CYP2E1 is found in breast cells known as mammary epithelial cells, which are also where most breast cancers originate, suggesting to the researchers that CYP2E1 may be involved in breast cancer development. To test this hypothesis, the researchers administered ethanol to separate cultures of mammary epithelial cells that had varying levels of CYP2E1. Cells that expressed low levels of CYP2E1 were mostly immune to the effects of the ethanol treatment; however, cells with increased amounts of CYP2E1 protein were greatly affected, suggesting that women with higher expression levels of the protein would show similar responses.

Significantly, points out Rodriguez-Fragoso, “our results showed that ethanol-treated human mammary cells had an increase in free radical production, oxidative stress and the activation of cellular mechanisms that cause cells to increase their proliferation rate,” all hallmarks of cancer. “So if you are a woman who naturally expresses higher levels of CYP2E1 and you consume alcohol, you would be at a greater risk for developing breast cancer than a woman who expresses lower amounts of CYP2E1,” she explains.

A few months ago, the group started investigating CYP2E1 expression levels in breast tissue obtained from healthy women who had undergone mammaplasties. “Preliminary results show that there is great variability in the expression of this enzyme among the analyzed samples,” says Rodriguez-Fragoso. “This means that each individual will have a different response to alcohol, and each should take different precautions to minimize their risk of developing breast cancer.”

With these results in hand, Rodriguez-Fragoso expressed confidence that her group will be able to develop a method of diagnosis that would focus on the determination of expression levels of CYP2E1 in breast tissue. “If you know the risk probability of certain behaviors on your likelihood of developing cancer, then you can better understand what preventative measures you should be taking,” she emphasizes.

The Center for Disease Control and Prevention estimates that breast cancer will be responsible for nearly 40,000 deaths this year alone, with an additional 220,000 diagnoses. “If we can prevent the development of breast cancer associated with alcohol intake by timely diagnoses of markers such as CYP2E1,” says Rodriguez-Fragoso, “then the annual numbers of new cases and deaths could be diminished significantly.”

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Study shows that minors who recognize ads for beer and spirits are more likely to drink

Minors who were familiar with television alcohol advertisements were more likely to have tried alcoholic beverages and binge drink than those who could not recall seeing such ads, according to a study to be presented Sunday, April 29, at the Pediatric Academic Societies (PAS) annual meeting in Boston.

“Underage drinking remains an important health risk in the U.S.,” said lead author Susanne E. Tanski, MD, MPH, FAAP, assistant professor in the Department of Pediatrics at Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center. “In this study, we have shown a link between recognition of nationally televised alcohol advertisements and underage drinking initiation and heavier use patterns.”

Previous research by Dr. Tanski and her colleagues showed an association between seeing smoking and drinking in movies and adolescents engaging in these risky behaviors. This study expanded on that research by exploring whether there is an association between young people’s exposure to television alcohol advertising and substance use.

The researchers surveyed a national sample of 2,541 youths ages 15 to 20 years. Participants were asked about their age, gender, race, if their friends drank, if their parents drank, whether they had a favorite alcohol ad and whether they owned alcohol-branded merchandise. They also were asked questions to assess whether they engaged in “sensation-seeking” behavior.

Participants then were shown 20 still images selected from television ads for the top beer and spirit alcohol brands that aired on national television in the year before the survey as well as 20 ads for fast-food restaurants. The images were digitally edited to remove the brands and logos. Individuals were asked if they remembered seeing the ad, if they liked the ad and if they knew the product or restaurant being advertised.

Results showed that 59 percent of underage youths previously drank alcohol. Of those who drank, 49 percent binge drank (had more than six drinks in a row) at least once in the past year.

Familiarity with TV alcohol advertising was significantly higher for drinkers than for non-drinkers. Other factors linked with drinking alcohol included older age, seeing alcohol in movies, having a favorite alcohol ad, having greater propensity for sensation seeking, having friends who drink alcohol, and having parents who drink alcohol at least weekly.

Among those who drank alcohol, familiarity with TV alcohol advertising was linked with greater alcohol use and binge drinking. Other factors linked with more hazardous drinking included owning alcohol-branded merchandise, having a favorite alcohol ad, older age, male gender, sensation seeking and friend drinking.

Familiarity with fast-food TV advertising was not linked to drinking behavior, suggesting that the relationship between alcohol ad familiarity and drinking is specific and not due to overall familiarity with advertising, Dr. Tanski said.

“At present, the alcohol industry employs voluntary standards to direct their advertising to audiences comprised of adults of legal drinking age,” Dr. Tanski said. “Our findings of high levels of familiarity with alcohol ads demonstrate that underage youth still frequently see these ads. While this study cannot determine which came first — the exposure to advertising or the drinking behavior — it does suggest that alcohol advertising may play a role in underage drinking, and the standards for alcohol ad placement perhaps should be more strict.”

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