Alcohol

Volume 67
Number 4
July 2006

Issues Available Online

Booth, B.M., Leukefeld, C., Falck, R., Wang, J., and Carlson, R. Correlates of Rural Methamphetamine and Cocaine Users: Results from a Multistate Community Study

ABSTRACT Objective: Use and production of methamphetamine (MA) has dramatically increased in the United States, especially in rural areas, with concomitant burdens on the treatment and criminal justice systems. However, cocaine is also widely used in many rural areas. The purpose of this article is to contrast MA and cocaine users in three geographically distinct rural areas of the United States. Method: Participants were recent not-in-treatment adult cocaine and MA users living in rural Ohio, Arkansas, and Kentucky, who were recruited by a referral recruitment method for sampling hidden community populations. Participants were interviewed for demographics, drug and alcohol use, criminal justice involvement, and psychological distress (Brief Symptom Inventory). Results: The sample of 706 comprised 29% nonwhite and 38% female participants; the average age was 32.6 years; 58% had a high school education or higher, and 32% were employed. In the past 6 months, they had used either MA only (13%), cocaine only (52%), or both (35%). MA users were seldom (8.2%) nonwhite, but type of stimulant use did not vary by gender. Combined MA/cocaine users reported significantly greater use of alcohol and other drugs, including marijuana and nonprescribed opiates and tranquilizers, and reported significantly higher psychological distress. MA users (with or without cocaine use) had greater odds of recent criminal justice involvement compared with cocaine-only users. Conclusions: There is a clear need for accessible substance-use treatment and prevention services in rural areas of the United States, including services that can address MA, cocaine, polydrug use, and mental health needs. There is a particular need of these services for polydrug users. ( J. Stud. Alcohol 67: 493-501, 2006)

Kodituwakku, P.W., Adnams, C.M., Hay, A., Kitching, A.E., Burger, E., Karlberg, W.O., Viljoen, D.L., and May, P.A. Letter and Category Fluency in Children With Fetal Alcohol Syndrome From a Community in South Africa

ABSTRACT. Objective: This study investigated whether there were differential effects of substantial prenatal alcohol exposure on letter and category fluency in children. Given that children with prenatal alcohol exposure are often impaired in executive functioning and that letter fluency taxes executive processes more than category fluency, it was expected that children with fetal alcohol syndrome (FAS) would be more impaired in letter than in category fluency. A second objective of the study was to examine the developmental trends in the two types of fluency in children with prenatal alcohol exposure. It was hypothesized that between the ages of 6 and 9 years, these FAS children would show age-related changes in category fluency but not in letter fluency. Method: As part of a neuropsychological test battery designed for an international collaborative study of FAS in South Africa, tests of letter and category fluency were administered in Afrikaans. The participants were 62 children with FAS and 61 controls matched with respect to age, gender (58 boys and 65 girls), ethnicity, and socioeconomic status. Results: Results showed that the FAS group had relatively greater difficulty with letter fluency than with category fluency and that the FAS group generated fewer words in both fluency conditions. Contrary to the expectation, however, alcohol-affected children demonstrated age-related linear trends in both letter and category fluency. Conclusions: This is the first study of verbal fluency involving a large sample of well-diagnosed children with FAS conducted in a nonwestern environment. The results are nonetheless consistent with those obtained in western countries in studies of children with various levels of prenatal alcohol exposure and various levels of fetal alcohol spectrum disorder. This study suggests that at least some aspects of the cognitive profile associated with prenatal alcohol exposure may be generalizable across cultural and ethnic boundaries. ( J. Stud. Alcohol 67: 502-509, 2006

Luczaj, W., Siemieniuk, E., Roszkowska-Jakimiec, W., and Skrzydlewska, E. Protective Effect of Black Tea Against Ethanol-Induced Oxidative Modifications of Liver Proteins and Lipids

ABSTRACT. Objective: Black tea has been recently ascertained as a source of water-soluble antioxidants that may enhance cellular antioxidant abilities. The present study was designed to investigate the efficacy of the preventive effect of black tea on oxidative modifications of liver lipids and proteins of 2-month-old rats intoxicated chronically (28 days) with ethanol. Method: Lipid peroxidation was estimated by measurement of lipid hydroperoxides, malondialdehyde, and 4-hydroxy­nonenal by high-performance liquid chromatography (HPLC) and by spectrophotometric determination of conjugated dienes. The markers of protein oxidative modification products—bistyrosine and tryptophan—were quantified by spectrofluorimetry, whereas levels of amino, sulfhydryl, and carbonyl groups were estimated spectrophotometrically. Results: Ethanol intoxication caused changes in liver antioxidant abilities that led to the generation of oxidative stress and, consequently, to the significant increase in products of lipid and protein oxidative modification. Enhanced lipid peroxidation was confirmed by assessment of the concentration of lipid peroxidation products measured at all examined levels. Protein modifications were evidenced by increase in levels of bistyrosine and carbonyl groups and by decrease in concentration of tryptophan and levels of sulfhydryl and amino groups. The metabolic consequences of oxidative modifications of lipids and proteins were reduced by cathepsin B activity and translocation of this lysosomal protease into cytosol as well as markers of liver damage—alanine aminotransferase (ALT) and aspartate aminotransferase (AST)—into the blood serum. Administration of black tea to ethanol-intoxicated rats partially protected antioxidant parameters and, remarkably, prevented the significant increase in concentrations of all measured lipid peroxidation products. Moreover, the levels of markers of the protein-modification process were similar to those of the control group. Protection of biological membranes by black tea prevents changes in the permeability of these membranes and translocation of the examined enzymes. Conclusions: Our findings indicate that black tea protects proteins and lipids against oxidative modification induced by chronic ethanol intoxication, which preserves changes in redox and proteolytic homeostasis. ( J. Stud. Alcohol 67: 510-518, 2006) ABSTRACT. Objective: Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission “naturally,” without formal treatment. We sought to describe the life history predictors of untreated remission among older adults. Method: We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters. Results: A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption. Conclusions: Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking. (J. Stud. Alcohol67: 354-362, 2006)

Miller, T.R., Levy, D.T., Spicer, R.S., and Taylor, D.M. Societal Costs of Underage Drinking

ABSTRACT. Objective: Despite minimum-purchase-age laws, young people regularly drink alcohol. This study estimated the magnitude and costs of problems resulting from underage drinking by category—traffic crashes, violence, property crime, suicide, burns, drownings, fetal alcohol syndrome, high-risk sex, poisonings, psychoses, and dependency treatment—and compared those costs with associated alcohol sales. Previous studies did not break out costs of alcohol problems by age. Method: For each category of alcohol-related problems, we estimated fatal and nonfatal cases attributable to underage alcohol use. We multiplied alcohol-attributable cases by estimated costs per case to obtain total costs for each problem. Results: Underage drinking accounted for at least 16% of alcohol sales in 2001. It led to 3,170 deaths and 2.6 million other harmful events. The estimated $61.9 billion bill (relative SE = 18.5%) included $5.4 billion in medical costs, $14.9 billion in work loss and other resource costs, and $41.6 billion in lost quality of life. Quality-of-life costs, which accounted for 67% of total costs, required challenging indirect measurement. Alcohol-attributable violence and traffic crashes dominated the costs. Leaving aside quality of life, the societal harm of $1 per drink consumed by an underage drinker exceeded the average purchase price of $0.90 or the associated $0.10 in tax revenues. Conclusions: Recent attention has focused on problems resulting from youth use of illicit drugs and tobacco. In light of the associated substantial injuries, deaths, and high costs to society, youth drinking behaviors merit the same kind of serious attention. (J. Stud. Alcohol 67: 519-528, 2006) ABSTRACT. Objective: The purpose of this study was to examine further alcohol treatment choice by using data from a nationally representative sample of adults with alcohol-use disorders to test which of three models—sequential, multinomial, or nested—best fit the data. The goals were to provide evidence about how this choice was made and to provide improved coefficient estimates, as well as to inform future analyses of treatment choice. Method: Data from the 2000 National Household Survey of Drug Abuse include respondents ages 18-64 reporting symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of alcohol abuse or dependence. A nested multinomial framework is used to determine the preferred model and to estimate the effect of respondents’ characteristics on the decisions to receive help and what kind of help to receive. Results: A sequential model, in which the choice of whether to receive help is unaffected by the level of satisfaction afforded by the alternatives, best fit the data. Older respondents had higher odds of both receiving help and choosing self-help, and those with a DSM-IV diagnosis of abuse had lower odds of receiving help but higher odds of entering self-help. Conclusions: The decision to receive help for alcohol problems appears unaffected by the perceived differences between these two broad categories of alternatives: self-help or formal treatment. This result may indicate the need to provide more information on the full range of treatment options to those for whom self-help may not be sufficient. (J. Stud. Alcohol67: 363-372, 2006)

McCabe, S.E., Cranford , J.A., Morales , M., and Young, A. Simultaneous and Concurrent Polydrug Use of Alcohol and Prescription Drugs: Prevalence, Correlates, and Consequences

ABSTRACT. Objective: In this study, we sought to examine the prevalence, correlates, and consequences associated with simultaneous polydrug use and concurrent polydrug use of alcohol and prescription drugs. For purposes of this investigation, simultaneous polydrug use referred to the co-ingestion of different drugs at the same time, and concurrent polydrug use referred to the use of different drugs on separate occasions within the past 12 months. Method: Undergraduate students attending a large public midwestern university in the United States were randomly selected to self-administer a Web survey. The sample consisted of 4,580 undergraduate students, with a mean (SD) age of 19.9 (2.0) years; the sample consisted of 50% women, and the racial breakdown was 65% white, 13% Asian, 7% black, 5% Hispanic, and 10% other race/ethnicity. The survey assessed simultaneous polydrug use and concurrent polydrug use of alcohol and four classes of prescription drugs: (1) pain medication, (2) stimulant medication, (3) sedative medication, and (4) sleeping medication. Results: The 12-month prevalence for polydrug use involving alcohol and abusable prescription drugs was 12.1% (including 6.9% simultaneous polydrug use). The majority of polydrug use involving alcohol and each class of prescription drugs was simultaneous polydrug use, with the exception of sleeping medication. Simultaneous polydrug use was more prevalent among undergraduate students who were male, were white, and reported early initiation of alcohol use. Simultaneous polydrug use was associated with more alcohol-related and other drug use-related problems than concurrent polydrug use. Conclusions: Based on the high prevalence and increased risk for consequences associated with simultaneous polydrug use of alcohol and prescription drugs, collegiate prevention efforts aimed at reducing substance abuse should clearly focus on co-ingestion of alcohol and prescription drugs. ( J. Stud. Alcohol 67: 529-537, 2006)