Journal of Studies on Alcohol and Drugs. Supplement最新文献

Objective: This article traces the evolution of alcohol-related social policy over the past 75 years.

Method: The literature was reviewed and is critically discussed.

Results: The social history of alcohol policies over the last 75 years began with the scientific approach to alcohol in the 1930s and later shifted to a central interest in the disease of alcoholism. Beginning with the National Council on Alcoholism Education, advocates struggled to "mainstream" treatment for this disease into the health care system. Major steps included decriminalization of public intoxication, emphasis of the social respectability of persons with alcohol problems, development of a treatment system that was accompanied by health insurance coverage, and work-based programs to identify and attract employed patients with health insurance coverage. These structures were considerably altered by the War on Drugs, managed care, and the merger of drug and alcohol treatment. The Affordable Care Act, however, has the potential for achieving the mainstreaming goals for alcohol problems originally conceived in the early 1940s.

Conclusions: Responsible involvement of the alcoholic beverage industry could greatly enhance current activities but is not likely to occur. Stigma persists in part because of associations with prevention and treatment of illegal drug use problems. The Affordable Care Act offers opportunities and challenges to the specialty of treating alcohol use disorders.

Objective: For the period of almost 75 years, we examined the literature for studies regarding the influences of culture on alcohol use and misuse.

Method: This review is a chronology of research articles published from 1940 to 2013. From a structured literature search with select criteria, 38 articles were identified and 34 reviewed.

Results: This analysis revealed a progression across this period of research from studies that began as descriptive ethnographic evaluations of one or more indigenous societies or cultural groups, evolving to studies using complex multivariate models to test cross-cultural effects in two or more cultural groups. Major findings across this period include the assertions that (a) a function of alcohol use may be to reduce anxiety, (b) certain cultural groups possess features of alcohol use that are not associated with negative consequences, (c) the disruptive effects of acculturative change and the stressors of new demands are associated with an increase in alcohol consumption, (d) cultural groups shape expectations about the effects of alcohol use and their definition of drunkenness, and (e) the hypothesized relationships of culture with alcohol use and misuse have been demonstrated in multivariate model analyses.

Conclusions: Across this 75-year period, the early proposition that culture is an important and prominent correlate of alcohol use and misuse has persisted. Within the current era of alcohol studies, this proposition has been supported by multivariate model analyses. Thus, the proposition that culture might affect alcohol use remains prominent and is as relevant today as it was when it was first proposed nearly 75 years ago.

Objective: In 2006, the nonprofit organization Choose Responsibility called for repealing the 1984 National Minimum Drinking Age Act, which had led all 50 states to establish a minimum legal drinking age (MLDA) of 21 years, and allowing the states to lower their MLDA to 18 years. Two years later, the organization assembled a small group of college and university presidents (the Amethyst Initiative) to call publicly for a critical reexamination of the law. Public health and traffic safety experts responded to these efforts by generating new research on the age 21 MLDA, thus warranting an updated review of the literature.

Method: This review focuses primarily on research published since 2006, when Choose Responsibility began its public relations campaign to lower the MLDA.

Results: Recent research on the age 21 MLDA has reinforced the position that the current law has served the nation well by reducing alcohol-related traffic crashes and alcohol consumption among youths, while also protecting drinkers from long-term negative outcomes they might experience in adulthood, including alcohol and other drug dependence, adverse birth outcomes, and suicide and homicide.

Conclusions: The age 21 law saves lives and is unlikely to be overturned. College and university leaders need to put into effect workable policies, stricter enforcement, and other evidence-based prevention efforts that have been demonstrated to reduce underage drinking and alcohol-related problems on campus and are being applied successfully at prominent academic institutions.

Objective: This article offers the author's assessment of the progress in research on alcohol related to alcohol misuse and alcohol use disorders.

Method: The historical background of alcohol-problem research is reviewed in the context of defining problems for study and the pattern by which research is funded.

Results: Progress in terms of cumulative research has been affected by the lack of central authority and the National Institutes of Health structure within which almost all funding for alcohol research in the United States has occurred. Problems are traced to the particular history and nature of alcohol-problem research, the continuing prominence of moral elements, and particular features of the treatment of alcohol use disorders.

Conclusions: Although the scope of activity and production of publications in alcohol research has expanded greatly during the past 75 years, there is a potential shortfall in the cumulative research that has led to solutions to major problems associated with alcohol.

Modern pharmacotherapy for alcohol dependence has its roots in the failure of National Prohibition in the United States and the rise of the disease model of alcoholism (embodied in Alcoholics Anonymous). In 1948, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence, but its efficacy has not been supported by randomized controlled trials. In the 1960s, benzodiazepines replaced older treatments for alcohol withdrawal, but sedative and dependence-producing effects limit their utility in the postwithdrawal period. In the 1980s, the focus shifted to the treatment of co-occurring psychiatric disorders and medications that modify negative mood states, which contribute to relapse to heavy drinking. In the 1990s, developments in neurobiology implicated specific neurotransmitter systems underlying alcohol's effects, culminating in the 1994 approval by the FDA of the opioid antagonist naltrexone to treat alcohol dependence. In 2006, the FDA approved a long-acting formulation of naltrexone. Recently, nalmefene, another opioid receptor antagonist, was approved in Europe for as-needed use to reduce heavy drinking. Acamprosate, an amino acid derivative, first approved in France in 1989, received FDA approval in 2004. However, the beneficial effects of the approved medications are only modestly greater than those of placebo, and their use is limited. Topiramate, currently under investigation for alcohol dependence, has greater efficacy but a variety of adverse effects. In addition to the identification of novel compounds, the future of alcohol dependence pharmacotherapy will depend on developments in pharmacogenetics, in which genetic variation that moderates treatment efficacy and adverse effects is used to personalize treatment.

Objective: This article reviews developments in research on genetic influences on alcohol and other drug use and disorders over the past 7 decades.

Method: The author began with a review of the flow and content of articles published in the three iterations of the journal since 1940 and then used a PubMed search of genetics of alcohol and other drug-related topics to gain a broad overview of developments in this field.

Results: The literature demonstrates the rapid metamorphosis of genetic research from the ideas of Mendel to an understanding that the substance use disorders are complex, genetically influenced conditions where genes explain up to 60% of the picture. Most genes operate through additional intermediate characteristics, such as impulsivity and a low sensitivity to alcohol, some of which are substance specific and others related to substances in general. Using linkage, association, genome-wide association, and other modern methods, investigators have identified a diverse range of genetic variations that affect substance-related phenomena.

Conclusions: Genetic studies regarding alcohol and other drug use and problems have grown dramatically in the past 75 years. We currently have a much more sophisticated understanding of these influences, and the rapid development of new methods has the promise of continuing what has been a solid contribution of important findings in recent years.

Objective: The aim of this study was to estimate, among college students ages 18-24, the numbers of alcohol-related unintentional injury deaths and other problems over the period from 1998 through 2005.

Method: The analysis integrated data on 18- to 24-year-olds and college students from each of the following data sources: the National Highway Traffic Safety Administration Fatality Analysis Reporting System, Centers for Disease Control and Prevention Injury Mortality Data, National Coroner Studies, census and college enrollment data, the National Household Survey on Drug Use and Health, and the College Alcohol Study.

Results: Among college students ages 18-24, alcohol-related unintentional injury deaths increased 3% per 100,000 from 1,440 in 1998 to 1,825 in 2005. From 1999 to 2005, the proportions of college students ages 18-24 who reported consuming five or more drinks on at least one occasion in the past month increased from 41.7% to 44.7%, and the proportions who drove under the influence of alcohol in the past year increased from 26.5% to 28.9%-7% and 9% proportional increases, respectively. The increases occurred among college students ages 21-24, not 18-20. In 2001, 599,000 (10.5%) full-time 4-year college students were injured because of drinking, 696,000 (12%) were hit or assaulted by another drinking college student, and 97,000 (2%) were victims of alcohol-related sexual assault or date rape. A 2005 follow-up of students in schools with the highest proportions of heavy drinkers found no significant changes in the proportions experiencing these events.

Conclusions: The persistence of college drinking problems underscores an urgent need to implement prevention and counseling approaches identified through research to reduce alcohol-related harms among college students and other young adults.

Objective: Research has found perceived descriptive norms to be one of the strongest predictors of college student drinking, and several intervention approaches have incorporated normative feedback to correct misperceptions of peer drinking behavior. Little research has focused on the role of the reference group in normative perceptions. The current study sought to examine whether normative perceptions vary based on specificity of the reference group and whether perceived norms for more specific reference-group norms are related to individual drinking behavior.

Method: Participants were first-year undergraduates (n = 1,276, 58% female) randomly selected from a university list of incoming students. Participants reported personal drinking behavior and perceived descriptive norms for eight reference groups, including typical student; same gender, ethnicity, or residence; and combinations of those reference groups (e.g., same gender and residence).

Results: Findings indicated that participants distinguished among different reference groups in estimating descriptive drinking norms. Moreover, results indicated misperceptions in drinking norms were evident at all levels of specificity of the reference group. Additionally, findings showed perceived norms for more specific groups were uniquely related to participants' own drinking.

Conclusions: These results suggest that providing normative feedback targeting at least one level of specificity to the participant (i.e., beyond what the "typical" student does) may be an important tool in normative feedback interventions.

Objective: The aims of this study were to (1) determine recognition of and self-reported concern regarding alcohol poisoning symptoms versus other alcohol-related behaviors among students turning 21 years old, (2) assess the frequency of helping behavior among students in situations where peers display alcohol poisoning symptoms, (3) assess sources from which students seek help, and (4) consider reasons why students report reluctance to seek help.

Method: Students (N = 306; 50% male) completed a Web-based self-report assessment during the week before their 21 st birthday focusing on drinking behavior, alcohol-related consequences, concern for symptoms of alcohol poisoning, and observations of and experience with helping behavior.

Results: Results indicated most students report having helped another student with symptoms of alcohol poisoning and show concern about the symptoms. Students most often seek help from other students and parents. When students do not help their peers, it is most often because of the perception that help is not needed. Heavier drinkers report a greater likelihood to help a peer showing symptoms of alcohol poisoning.

Conclusions: Prevention professionals should incorporate students, friends, and parents in interventions that provide knowledge and helping strategies for alcohol poisoning symptoms. In addition, prevention efforts regarding alcohol poisoning should focus on heavy drinkers, as they are most likely to be in situations requiring help. Finally, administrators implementing medical amnesty policies should couple those policies with educational strategies aimed at recognition of alcohol poisoning symptoms.

Objective: This study examined characteristics of students who presented to a college health center and screened positive for the 5/4 definition of high-risk drinking (five or more drinks in a row for men, or four or more drinks in a row for women, on at least one occasion in the past 2 weeks) and analyzed the students' data according to their reporting of alcohol-related harms.

Method: Secondary analysis of data obtained for an intervention study to reduce high-risk drinking in college students was used. Data on alcohol use and alcohol-related harms were obtained from Web-based Healthy Lifestyle Questionnaires and 30-day alcohol recall diaries (Timeline Followback calendar). Students (N = 363; 52% female) were classified as nonheavy, heavy, and heavy and frequent drinkers, based on their self-reported alcohol use. Alcohol-related harms were measured using the Rutgers Alcohol Problem Index and eight additional items derived from the Drinker Inventory of Consequences-2L.

Results: Students in the nonheavy, heavy, and heavy and frequent groups had mean Rutgers Alcohol Problem Index scores of 10, 14, and 23, respectively. The heavy-and-frequent drinking group comprised 20% of the sample but experienced 31% of the total harms.

Conclusions: The 5/4 screening question accurately identified college students presenting to a college health center who were already experiencing significant alcohol-related harms. The addition of a frequency question (drinking 3 or more days per week) to the 5/4 screening question provided a simple method for identifying those students at highest risk and in greatest need of intervention.