Pub Date : 2021-02-11DOI: 10.1108/DAT-07-2020-0050
Eduardo Tejedor Tejada, Domiciana De la Fuente Marcos, Maria Jesus Cuesta Lozano, J. González, Jesús Moro Aguado, Jesús Tejedor Muñoz
Purpose This study aims to assess the potency and dose of Δ-9-Tetrahidrocannabinol (THC) and Cannabidiol (CBD) in cannabis joints. This will enable better estimates of the degree of exposure in a user and contribute towards a better understanding of potential harmful effects. Design/methodology/approach Analysis of intact joints confiscated by law enforcement on the street in the autonomous region of Castilla y León (Spain) during the years 2017–2019. Findings This study analysed THC, CBN and CBD in marijuana joints (N = 744). Joints contain cannabis and tobacco (N = 729), had a median net weight 0.69 g (IQR = 0.28); concentration THC median was 6.30%(IQR = 4.51) and THC median dose 42 mg (IQR = 32.75). A total of 35.5% mixed joints contained CBN – median percentage 0.61% (IQR = 0.51). CBD was detected 10.3% of mixed joints – median percentage 0.13% (IQR = 0.12) and median dose 1 mg (IQR = 0.92). CBD/THC ratio presented median value of 0.02 (IQR = 0.02). The samples analysed comprised pure cannabis joints (N = 15), with THC median 11.86% (IWR = 6.30) or median dose of 118 mg. Originality/value The study found high values for concentration and dose of THC and CBD in cannabis joints, warning of high exposures for the user and associated potential consequences. The results obtained contribute new perspectives on the definition of a standard cannabis unit.
{"title":"Concentration of tetrahidrocannabinol in joints","authors":"Eduardo Tejedor Tejada, Domiciana De la Fuente Marcos, Maria Jesus Cuesta Lozano, J. González, Jesús Moro Aguado, Jesús Tejedor Muñoz","doi":"10.1108/DAT-07-2020-0050","DOIUrl":"https://doi.org/10.1108/DAT-07-2020-0050","url":null,"abstract":"\u0000Purpose\u0000This study aims to assess the potency and dose of Δ-9-Tetrahidrocannabinol (THC) and Cannabidiol (CBD) in cannabis joints. This will enable better estimates of the degree of exposure in a user and contribute towards a better understanding of potential harmful effects.\u0000\u0000\u0000Design/methodology/approach\u0000Analysis of intact joints confiscated by law enforcement on the street in the autonomous region of Castilla y León (Spain) during the years 2017–2019.\u0000\u0000\u0000Findings\u0000This study analysed THC, CBN and CBD in marijuana joints (N = 744). Joints contain cannabis and tobacco (N = 729), had a median net weight 0.69 g (IQR = 0.28); concentration THC median was 6.30%(IQR = 4.51) and THC median dose 42 mg (IQR = 32.75). A total of 35.5% mixed joints contained CBN – median percentage 0.61% (IQR = 0.51). CBD was detected 10.3% of mixed joints – median percentage 0.13% (IQR = 0.12) and median dose 1 mg (IQR = 0.92). CBD/THC ratio presented median value of 0.02 (IQR = 0.02). The samples analysed comprised pure cannabis joints (N = 15), with THC median 11.86% (IWR = 6.30) or median dose of 118 mg.\u0000\u0000\u0000Originality/value\u0000The study found high values for concentration and dose of THC and CBD in cannabis joints, warning of high exposures for the user and associated potential consequences. The results obtained contribute new perspectives on the definition of a standard cannabis unit.\u0000","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49294493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alfred Uhl, Julian Strizek, Blaine Stothard, Axel Klein, Aysel Sultan
Drug use reports are increasingly drawing attention to the risks attendant to the extra-medical use of prescription drugs among a variety of subpopulations. The field, which for years has been focussed on illicit drugs, has been taken unawares by the sudden rise in overdose mortality and blood-borne virus incidents associated with prescription drug use (Degenhardt et al., 2019; Farrell et al., 2019). Political agencies raising attention to aspects of this phenomenon have tried to tailor the problem to their mandate. The ministerial segment from the 62nd session of the Commission on Narcotic Drugs has therefore focussed on opioid prescription drugs such as fentanyl and tramadol with extensive discussions over the need for concerted international action (UNODC, 2019a).
{"title":"Guest editorial","authors":"Alfred Uhl, Julian Strizek, Blaine Stothard, Axel Klein, Aysel Sultan","doi":"10.1108/dat-03-2021-077","DOIUrl":"https://doi.org/10.1108/dat-03-2021-077","url":null,"abstract":"Drug use reports are increasingly drawing attention to the risks attendant to the extra-medical use of prescription drugs among a variety of subpopulations. The field, which for years has been focussed on illicit drugs, has been taken unawares by the sudden rise in overdose mortality and blood-borne virus incidents associated with prescription drug use (Degenhardt et al., 2019; Farrell et al., 2019). Political agencies raising attention to aspects of this phenomenon have tried to tailor the problem to their mandate. The ministerial segment from the 62nd session of the Commission on Narcotic Drugs has therefore focussed on opioid prescription drugs such as fentanyl and tramadol with extensive discussions over the need for concerted international action (UNODC, 2019a).","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49034123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-02DOI: 10.1108/DAT-08-2020-0054
D. Jones, Paloma Dulbecco, Santiago L. Cunial
Purpose The purpose of this paper is to inquire into the role that sexuality plays in faith-based programs for the prevention and care of problematic drug use. Design/methodology/approach This paper conducts 25 semi-structured interviews with institutional staff and another 31 with people undergoing treatment in spiritual and religious drug rehabilitation programs in Argentina. Findings First, within these therapeutic devices, different sexual experiences are considered initial catalysts for drug use. Also, within these institutions, certain morally condemned sexual behaviors are seen as associated with consumption. Second, these institutions establish diverse rules and recommendations about intimate relationships for people in recovery to improve the outcome of treatments. Third, therapeutic institutions produce gender stereotypes related to the sexuality of drug users. Fourth, institutions assume heterosexuality within their target populations, thereby reinforcing the heteronormative frameworks of these therapeutic interventions. Research limitations/implications This is a small qualitative study conducted in Argentina. Although its results cannot be generalized, they serve as a preliminary empirical input to analyze drug treatment programs in the country and other regions of the world. Originality/value This study addresses the relationships between problematic drug use, rehabilitation and sexuality from the perspectives of both professionals and men and women who consume drugs. This paper adopts a critical perspective on gender and sexual diversity to analyze how therapeutic institutions reproduce certain gender stereotypes and heteronormativity. In doing so, the research intends to contribute to discussions that can lead to more comprehensive policies regarding problematic drug use.
{"title":"The role of sexuality in religious responses to problematic drug use in Argentina","authors":"D. Jones, Paloma Dulbecco, Santiago L. Cunial","doi":"10.1108/DAT-08-2020-0054","DOIUrl":"https://doi.org/10.1108/DAT-08-2020-0054","url":null,"abstract":"\u0000Purpose\u0000The purpose of this paper is to inquire into the role that sexuality plays in faith-based programs for the prevention and care of problematic drug use.\u0000\u0000\u0000Design/methodology/approach\u0000This paper conducts 25 semi-structured interviews with institutional staff and another 31 with people undergoing treatment in spiritual and religious drug rehabilitation programs in Argentina.\u0000\u0000\u0000Findings\u0000First, within these therapeutic devices, different sexual experiences are considered initial catalysts for drug use. Also, within these institutions, certain morally condemned sexual behaviors are seen as associated with consumption. Second, these institutions establish diverse rules and recommendations about intimate relationships for people in recovery to improve the outcome of treatments. Third, therapeutic institutions produce gender stereotypes related to the sexuality of drug users. Fourth, institutions assume heterosexuality within their target populations, thereby reinforcing the heteronormative frameworks of these therapeutic interventions.\u0000\u0000\u0000Research limitations/implications\u0000This is a small qualitative study conducted in Argentina. Although its results cannot be generalized, they serve as a preliminary empirical input to analyze drug treatment programs in the country and other regions of the world.\u0000\u0000\u0000Originality/value\u0000This study addresses the relationships between problematic drug use, rehabilitation and sexuality from the perspectives of both professionals and men and women who consume drugs. This paper adopts a critical perspective on gender and sexual diversity to analyze how therapeutic institutions reproduce certain gender stereotypes and heteronormativity. In doing so, the research intends to contribute to discussions that can lead to more comprehensive policies regarding problematic drug use.\u0000","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49081650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-15DOI: 10.1108/DAT-09-2020-0061
R. Ellison, M. Grønbæk, E. Skovenborg
This paper aims to evaluate the use of Mendelian randomization (MR) analyses for judging the effects of alcohol consumption on the risk of coronary heart disease (CHD).,This paper presents a review of methodology for MR and describes its early application to judging health effects of alcohol, current uses and a recommended approach of combining MR results with those from observational and experimental studies.,Early applications of MR to health effects of alcohol consumption were inadequate for providing unbiased results, but newer attempts using polygenic scores show promise. It is important to combine data from MR analyses with those from observational and experimental studies to obtain an unbiased and scientifically sound estimate of alcohol’s effects on health.,Giving advice to the public regarding alcohol consumption must be based on accurate, unbiased scientific data; this paper describes attempts to use MR for achieving this goal.,Given that light-to-moderate alcohol intake is associated with a lower risk of CHD, type II diabetes mellitus and total mortality, it is important to be able to evaluate both the benefits and harms from alcohol before giving advice regarding drinking.,This is part of a group of three papers dealing with the potential health benefits and harms associated with alcohol consumption.
{"title":"Using Mendelian randomization to evaluate the effects of alcohol consumption on the risk of coronary heart disease","authors":"R. Ellison, M. Grønbæk, E. Skovenborg","doi":"10.1108/DAT-09-2020-0061","DOIUrl":"https://doi.org/10.1108/DAT-09-2020-0061","url":null,"abstract":"This paper aims to evaluate the use of Mendelian randomization (MR) analyses for judging the effects of alcohol consumption on the risk of coronary heart disease (CHD).,This paper presents a review of methodology for MR and describes its early application to judging health effects of alcohol, current uses and a recommended approach of combining MR results with those from observational and experimental studies.,Early applications of MR to health effects of alcohol consumption were inadequate for providing unbiased results, but newer attempts using polygenic scores show promise. It is important to combine data from MR analyses with those from observational and experimental studies to obtain an unbiased and scientifically sound estimate of alcohol’s effects on health.,Giving advice to the public regarding alcohol consumption must be based on accurate, unbiased scientific data; this paper describes attempts to use MR for achieving this goal.,Given that light-to-moderate alcohol intake is associated with a lower risk of CHD, type II diabetes mellitus and total mortality, it is important to be able to evaluate both the benefits and harms from alcohol before giving advice regarding drinking.,This is part of a group of three papers dealing with the potential health benefits and harms associated with alcohol consumption.","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44103426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-08DOI: 10.1108/DAT-10-2020-0065
J. Körkel
This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently.,The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed).,The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities.,Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.,To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.,OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.,The OTAT approach has not been described in the addiction treatment literature so far.
{"title":"Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment","authors":"J. Körkel","doi":"10.1108/DAT-10-2020-0065","DOIUrl":"https://doi.org/10.1108/DAT-10-2020-0065","url":null,"abstract":"This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently.,The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed).,The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities.,Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.,To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.,OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.,The OTAT approach has not been described in the addiction treatment literature so far.","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49609825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-31DOI: 10.1108/dat-10-2020-0063
G. Bischof, Nikolaus Lange, H. Rumpf, U. Preuss
The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time.,A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented.,Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce.,Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.
{"title":"Reduced drinking and harm reduction in the treatment of alcohol use disorders","authors":"G. Bischof, Nikolaus Lange, H. Rumpf, U. Preuss","doi":"10.1108/dat-10-2020-0063","DOIUrl":"https://doi.org/10.1108/dat-10-2020-0063","url":null,"abstract":"The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time.,A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented.,Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce.,Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46067538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-30DOI: 10.1108/dat-12-2019-0048
Nicolae Eduard Craciunescu
Purpose The purpose of this study is to explore drug consumption from a cultural perspective, in the context of the consumer culture. It aims to identify if, through the branding process, cryptomarket vendors are attaching a sign-value to their products to facilitate the process by which consumers will recognize and appreciate it. Design/methodology/approach The study was done by performing a qualitative content analysis loosely inspired from semiotics on a sample of 40 seller pages from the Dream Market and samples of their listings, collected in 2018. The vendors who had over 1,000 successful transactions were selected, as they were considered to be the ones who have gained a certain level of trust on the cryptomarket and were considered to having to compete by differentiating their services through their brands of choice. Findings The results have shown that the sign-value attached to the drugs sold by the vendors from this sample can be divided in two different types of sign-systems: the popular culture and the drug cultures. The popular culture includes sign-value borrowed from established brands, popular media and media representations of crime worlds. The drug cultures include values from three types of subcultural systems: cannabis, party and psychonaut subculture. Originality/value The study is trying to stir the discussions around the regulation of the drug markets by looking at the market forces within them as rather a product of consumer capitalism and not as processes that happen outside the postmodern cultural and societal trends.
{"title":"Drugs, brands and consumer culture: the sign-value of the products sold on the darknet marketplaces","authors":"Nicolae Eduard Craciunescu","doi":"10.1108/dat-12-2019-0048","DOIUrl":"https://doi.org/10.1108/dat-12-2019-0048","url":null,"abstract":"\u0000Purpose\u0000The purpose of this study is to explore drug consumption from a cultural perspective, in the context of the consumer culture. It aims to identify if, through the branding process, cryptomarket vendors are attaching a sign-value to their products to facilitate the process by which consumers will recognize and appreciate it.\u0000\u0000\u0000Design/methodology/approach\u0000The study was done by performing a qualitative content analysis loosely inspired from semiotics on a sample of 40 seller pages from the Dream Market and samples of their listings, collected in 2018. The vendors who had over 1,000 successful transactions were selected, as they were considered to be the ones who have gained a certain level of trust on the cryptomarket and were considered to having to compete by differentiating their services through their brands of choice.\u0000\u0000\u0000Findings\u0000The results have shown that the sign-value attached to the drugs sold by the vendors from this sample can be divided in two different types of sign-systems: the popular culture and the drug cultures. The popular culture includes sign-value borrowed from established brands, popular media and media representations of crime worlds. The drug cultures include values from three types of subcultural systems: cannabis, party and psychonaut subculture.\u0000\u0000\u0000Originality/value\u0000The study is trying to stir the discussions around the regulation of the drug markets by looking at the market forces within them as rather a product of consumer capitalism and not as processes that happen outside the postmodern cultural and societal trends.\u0000","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46155534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-23DOI: 10.1108/dat-09-2020-0059
E. Skovenborg, M. Grønbæk, R. Ellison
The purpose of this paper is a review of updated evidence of a J-shaped association between alcohol consumption and the risk of coronary heart disease (CHD) and all-cause mortality in relation to public health issues to create a basis for sensible individual health deliberations.,A review of the evidence from the first observation of a J-shaped association between a moderate alcohol intake and CHD in 1926 to recent studies of the effect of healthy lifestyles (including moderate alcohol intake) on life expectancy free of cardiovascular disease (CVD), cancer and Type 2 diabetes. An update on the biological plausibility of the J-shaped association with focus on recent findings of the association of alcohol intake and blood lipid levels.,Plausible J-shaped relations between light to moderate alcohol consumption and the risk of CHD, CVD mortality and all-cause mortality have been found in a large number of robust epidemiological studies. Among the potential mechanisms underlying the proposed protective effects are higher levels of high-density lipoprotein lacking apolipoprotein C3, reduced platelet aggregability, increased level of endothelial cell fibrinolysis, increased insulin sensitivity and decreased inflammation.,The existence of a J-shaped association between alcohol consumption and the risk of CHD and all-cause mortality is based on observational evidence and accordingly challenged by a degree of uncertainty leading some public health circles to state: “there is no safe level of alcohol consumption.” The authors propose that communication on the pros and cons of alcohol intake should emphasize the nadir of a J-shaped curve as a healthy range for the general population while advice regarding the consumption of alcohol should be adjusted to factor in the risks and potential benefits for each individual patient considering age, sex, family history, personal drinking history and specific medical history.
{"title":"Benefits and hazards of alcohol-the J-shaped curve and public health","authors":"E. Skovenborg, M. Grønbæk, R. Ellison","doi":"10.1108/dat-09-2020-0059","DOIUrl":"https://doi.org/10.1108/dat-09-2020-0059","url":null,"abstract":"The purpose of this paper is a review of updated evidence of a J-shaped association between alcohol consumption and the risk of coronary heart disease (CHD) and all-cause mortality in relation to public health issues to create a basis for sensible individual health deliberations.,A review of the evidence from the first observation of a J-shaped association between a moderate alcohol intake and CHD in 1926 to recent studies of the effect of healthy lifestyles (including moderate alcohol intake) on life expectancy free of cardiovascular disease (CVD), cancer and Type 2 diabetes. An update on the biological plausibility of the J-shaped association with focus on recent findings of the association of alcohol intake and blood lipid levels.,Plausible J-shaped relations between light to moderate alcohol consumption and the risk of CHD, CVD mortality and all-cause mortality have been found in a large number of robust epidemiological studies. Among the potential mechanisms underlying the proposed protective effects are higher levels of high-density lipoprotein lacking apolipoprotein C3, reduced platelet aggregability, increased level of endothelial cell fibrinolysis, increased insulin sensitivity and decreased inflammation.,The existence of a J-shaped association between alcohol consumption and the risk of CHD and all-cause mortality is based on observational evidence and accordingly challenged by a degree of uncertainty leading some public health circles to state: “there is no safe level of alcohol consumption.” The authors propose that communication on the pros and cons of alcohol intake should emphasize the nadir of a J-shaped curve as a healthy range for the general population while advice regarding the consumption of alcohol should be adjusted to factor in the risks and potential benefits for each individual patient considering age, sex, family history, personal drinking history and specific medical history.","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48417452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-23DOI: 10.1108/dat-09-2020-0060
M. Grønbæk, R. Ellison, E. Skovenborg
The purpose of this paper is to review the conceptual and methodological challenges of a J-shaped association between alcohol consumption (AC), coronary heart disease (CHD) and all-cause mortality. In associated papers in this journal, Skovenborg et al., 2021 reviews the evidence for the J-shaped curve, and Ellison et al., 2021 examines the advantages and drawbacks of Mendelian randomization studies of the J-shaped curve.,A number of methodological problems are common in observational research in general, and some of the methodological problems suggested for the J-shaped alcohol-CHD-associations are discussed. The extent of the methodological problems in studies of the J-shaped curve is reviewed, and the possibility that the J-shaped curve is an artifact created by reverse causality and residual confounding is discussed. Further, the issue of interaction with drinking pattern and type of alcohol is discussed.,Imprecise categorization of alcohol intake information seems to have had little effect on the J-shaped alcohol-CHD-associations, nor has it affected the ability of these studies to show increasing mortality from a range of causes with increasing AC. The problem of “sick quitters” has been resolved by large studies using lifelong abstainers or infrequent drinkers as reference group. Many studies lack information on drinking patterns with regard to regular, moderate consumption versus binge drinking. Stratified analyses by important risk factors for CHD have not significantly changed the J-shaped association observed in most epidemiologic studies.,Potential biases and residual confounding probably do not overcome the J-shaped alcohol-CDH-association observed in most epidemiologic studies; however, the existence of a J-shaped curve is challenged by some degree of uncertainty. The actual review together with the associated papers by Skovenborg et al., 2021 and Ellison et al., 2021 offers a possibility to “update your priors” and achieve greater certainty when giving your patients information on the pros and cons of alcohol intake.
{"title":"The J-shaped curve-conceptual and methodological challenges","authors":"M. Grønbæk, R. Ellison, E. Skovenborg","doi":"10.1108/dat-09-2020-0060","DOIUrl":"https://doi.org/10.1108/dat-09-2020-0060","url":null,"abstract":"The purpose of this paper is to review the conceptual and methodological challenges of a J-shaped association between alcohol consumption (AC), coronary heart disease (CHD) and all-cause mortality. In associated papers in this journal, Skovenborg et al., 2021 reviews the evidence for the J-shaped curve, and Ellison et al., 2021 examines the advantages and drawbacks of Mendelian randomization studies of the J-shaped curve.,A number of methodological problems are common in observational research in general, and some of the methodological problems suggested for the J-shaped alcohol-CHD-associations are discussed. The extent of the methodological problems in studies of the J-shaped curve is reviewed, and the possibility that the J-shaped curve is an artifact created by reverse causality and residual confounding is discussed. Further, the issue of interaction with drinking pattern and type of alcohol is discussed.,Imprecise categorization of alcohol intake information seems to have had little effect on the J-shaped alcohol-CHD-associations, nor has it affected the ability of these studies to show increasing mortality from a range of causes with increasing AC. The problem of “sick quitters” has been resolved by large studies using lifelong abstainers or infrequent drinkers as reference group. Many studies lack information on drinking patterns with regard to regular, moderate consumption versus binge drinking. Stratified analyses by important risk factors for CHD have not significantly changed the J-shaped association observed in most epidemiologic studies.,Potential biases and residual confounding probably do not overcome the J-shaped alcohol-CDH-association observed in most epidemiologic studies; however, the existence of a J-shaped curve is challenged by some degree of uncertainty. The actual review together with the associated papers by Skovenborg et al., 2021 and Ellison et al., 2021 offers a possibility to “update your priors” and achieve greater certainty when giving your patients information on the pros and cons of alcohol intake.","PeriodicalId":44780,"journal":{"name":"Drugs and Alcohol Today","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2020-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47594199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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