Alcohol Research : Current Reviews最新文献

Long-lasting changes in synaptic function (i.e., synaptic plasticity) have long been thought to contribute to information storage in the nervous system. Although synaptic plasticity mainly has adaptive functions that allow the organism to function in complex environments, it is now clear that certain events or exposure to various substances can produce plasticity that has negative consequences for organisms. Exposure to drugs of abuse, in particular ethanol, is a life experience that can activate or alter synaptic plasticity, often resulting in increased drug seeking and taking and in many cases addiction.Two brain regions subject to alcohol's effects on synaptic plasticity are the striatum and bed nucleus of the stria terminalis (BNST), both of which have key roles in alcohol's actions and control of intake. The specific effects depend on both the brain region analyzed (e.g., specific subregions of the striatum and BNST) and the duration of ethanol exposure (i.e., acute vs. chronic). Plastic changes in synaptic transmission in these two brain regions following prolonged ethanol exposure are thought to contribute to excessive alcohol drinking and relapse to drinking. Understanding the mechanisms underlying this plasticity may lead to new therapies for treatment of these and other aspects of alcohol use disorder.

Research on the use of mobile technologies for alcohol use problems is a developing field. Rapid technological advances in mobile health (or mHealth) research generate both opportunities and challenges, including how to create scalable systems capable of collecting unprecedented amounts of data and conducting interventions-some in real time-while at the same time protecting the privacy and safety of research participants. Although the research literature in this area is sparse, lessons can be borrowed from other communities, such as cybersecurity or Internet security, which offer many techniques to reduce the potential risk of data breaches or tampering in mHealth. More research into measures to minimize risk to privacy and security effectively in mHealth is needed. Even so, progress in mHealth research should not stop while the field waits for perfect solutions.

Heavy drinking causes significant morbidity, premature mortality, and other social and economic burdens on society, prompting numerous prevention and treatment efforts to avoid or ameliorate the prevalence of heavy drinking and its consequences. However, the impact on public health of current selective (i.e., clinical) prevention and treatment strategies is unclear. Screening and brief counseling for at-risk drinkers in ambulatory primary care has the strongest evidence for efficacy, and some evidence indicates this approach is cost-effective and reduces excess morbidity and dysfunction. Widespread implementation of screening and brief counseling of nondependent heavy drinkers outside of the medical context has the potential to have a large public health impact. For people with functional dependence, no appropriate treatment and prevention approaches currently exist, although such strategies might be able to prevent or reduce the morbidity and other harmful consequences associated with the condition before its eventual natural resolution. For people with alcohol use disorders, particularly severe and recurrent dependence, treatment studies have shown improvement in the short term. However, there is no compelling evidence that treatment of alcohol use disorders has resulted in reductions in overall disease burden. More research is needed on ways to address functional alcohol dependence as well as severe and recurrent alcohol dependence.

Although light-to-moderate drinking among women is associated with reduced risks of some cardiovascular problems, strokes, and weakening of bones, such levels of drinking also are associated with increased risks of breast cancer and liver problems, and heavy drinking increases risks of hypertension and bone fractures and injuries. Women's heavy-drinking patterns and alcohol use disorders are associated with increased likelihood of many psychiatric problems, including depression, posttraumatic stress disorder, eating disorders, and suicidality, as well as increased risks of intimate partner violence and sexual assault, although causality in the associations of drinking with psychiatric disorders and with violence remains unclear. It is important for women to be aware of the risks associated with alcohol use, especially because gaps between U.S. men's and women's drinking may have narrowed. However, analyses of health risks and benefits need mprovement to avoid giving women oversimplified advice about drinking.

Hospital emergency departments (EDs) see many patients with alcohol-related injuries and therefore frequently are used to assess the relationship between alcohol consumption and injury risk. These studies typically use either case-control or case-crossover designs. Case-control studies, which compare injured ED patients with either medical ED patients or the general population, found an increased risk of injury after alcohol consumption, but differences between the case and control subjects partly may account for this effect. Case-crossover designs, which avoid this potential confounding factor by using the injured patients as their own control subjects, also found elevated rates of injury risk after alcohol consumption. However, the degree to which risk is increased can vary depending on the study design used. Other factors influencing injury risk include concurrent use of other drugs and drinking patterns. Additional studies have evaluated cross-country variation in injury risk as well as the risk by type (i.e., intentional vs. unintentional) and cause of the injury. Finally, ED studies have helped determine the alcohol-attributable fraction of injuries, the causal attribution of injuries to drinking, and the impact of others' drinking. Although these studies have some limitations, they have provided valuable insight into the association between drinking and injury risk.

Alcohol consumption is differentially associated with social and health harms across U.S. ethnic groups. Native Americans, Hispanics, and Blacks are disadvantaged by alcohol-attributed harms compared with Whites and Asians. Ethnicities with higher rates of risky drinking experience higher rates of drinking harms. Other factors that could contribute to the different effects of alcohol by ethnicity are social disadvantage, acculturation, drink preferences, and alcohol metabolism. This article examines the relationship of ethnicity and drinking to (1) unintentional injuries, (2) intentional injuries, (3) fetal alcohol syndrome (FAS), (4) gastrointestinal diseases, (5) cardiovascular diseases, (6) cancers, (7) diabetes, and (8) infectious diseases. Reviewed evidence shows that Native Americans have a disproportionate risk for alcohol-related motor vehicle fatalities, suicides and violence, FAS, and liver disease mortality. Hispanics are at increased risk for alcohol-related motor vehicle fatalities, suicide, liver disease, and cirrhosis mortality; and Blacks have increased risk for alcohol-related relationship violence, FAS, heart disease, and some cancers. However, the scientific evidence is incomplete for each of these harms. More research is needed on the relationship of alcohol consumption to cancers, diabetes, and HIV/AIDS across ethnic groups. Studies also are needed to delineate the mechanisms that give rise to and sustain these disparities in order to inform prevention strategies.

Measuring the impact of alcohol consumption on morbidity and mortality depends on the accurate measurement of alcohol exposure, risk relationships, and outcomes. A variety of complicating factors make it difficult to measure these elements. This article reviews these factors and provides an overview of the articles that make up this special issue on current research examining alcohol's role in the burden of disease. These topics include estimating alcohol consumption as well as alcohol-related morbidity and mortality in various demographic groups, and the burden of alcohol use disorders.

Alcohol consumption is a risk factor for many chronic diseases and conditions. The average volume of alcohol consumed, consumption patterns, and quality of the alcoholic beverages consumed likely have a causal impact on the mortality and morbidity related to chronic diseases and conditions. Twenty-five chronic disease and condition codes in the International Classification of Disease (ICD)-10 are entirely attributable to alcohol, and alcohol plays a component-risk role in certain cancers, other tumors, neuropsychiatric conditions, and numerous cardiovascular and digestive diseases. Furthermore, alcohol has both beneficial and detrimental impacts on diabetes, ischemic stroke, and ischemic heart disease, depending on the overall volume of alcohol consumed, and, in the case of ischemic diseases, consumption patterns. However, limitations exist to the methods used to calculate the relative risks and alcohol-attributable fractions. Furthermore, new studies and confounders may lead to additional diseases being causally linked to alcohol consumption, or may disprove the relationship between alcohol consumption and certain diseases that currently are considered to be causally linked. These limitations do not affect the conclusion that alcohol consumption significantly contributes to the burden of chronic diseases and conditions globally, and that this burden should be a target for intervention.