A new analysis has shown that combined behavioral intervention (CBI), counseling that integrates cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participation, used alone in conjunction with naltrexone, a drug approved to help treat alcoholism, can reduce drinking in alcohol-dependent individuals. In this reanalysis of data from the COMBINE Study—the largest pharmacotherapy trial for alcoholism in the United States—researchers identified clinically useful trajectories of drinking (abstainers, infrequent drinkers, frequent to infrequent drinkers, increasing to frequent drinkers, increasing-to-nearly daily drinkers, and nearly daily drinkers). In addition, researchers determined that naltrexone reduced the chance that participants would follow a nearly daily drinking trajectory, and that CBI reduced participants' chance of following an increasing to nearly daily trajectory. Combining naltrexone and CBI, however, increased the chance of membership in a trajectory with a declining frequency of any drinking over time.
Because original COMBINE analysis showed no treatment advantage for naltrexone plus CBI, the researchers believe that trajectory analysis of COMBINE data provide a more complete representation of drinking during treatment and the effects of treatments on different aspects of drinking. These results reveal that certain subgroups of individuals may benefit more from specific treatments than is apparent from summary measures of COMBINE data.
Brief counseling sessions by physicians can help college students reduce harmful alcohol use, according to a new study supported by NIAAA. Led by Michael F. Fleming, M.D., M.P.H., of the University of Wisconsin, the study is part of the ongoing College Health Intervention Projects (CHIPs) study, a randomized, controlled clinical trial conducted in five college health clinics in Wisconsin, Washington state, and Vancouver, Canada. College health service clinicians examined whether brief counseling sessions would reduce the rates of heavy alcohol use and alcohol-related harm among the nearly 1,000 heavy-drinking students enrolled in the study. After a 12 month follow-up period, alcohol consumption had reduced in the experimental group by 27.2%, compared with a 21% reduction among students in a control group. Heavy episodic drinking also declined by 26.3% in the experimental group, and 23.3% in the control group. This study adds to growing evidence that college health clinic visits are "teachable moments" during which clinicians can help address harmful alcohol use by students.
It is no surprise that some college-age men and women drink heavily, and can be victims of dating violence as a result. But a recent study by Cynthia Stappenbeck and Kim Fromme at the University of Texas at Austin demonstrates that these behaviors can affect men and women in different ways.
The researchers recruited 2,247 incoming freshmen to complete Internet-based assessments about their drinking and dating behaviors at the end of each fall and spring semester of their first three years of college. The students answered questions designed to assess the details of any dating violence. The questionnaire also asked participants about drinking behavior, including how often they engaged in binge drinking, defined as five or more drinks for men and four or more drinks for women, and the number of times they felt drunk.
Stappenbeck and Fromme found that 19 percent of the participants experienced physical dating violence at some point during the three year assessment period. 73 percent of participants who acknowledged involvement in violent relationships were female.
The researchers discovered that men who drank most heavily during their freshmen year of college engaged in more violence in their dating relationships during that same year than men who drank less heavily. Heavy drinking, however, did not predict subsequent dating violence for men. By contrast, women who drank heavily during their sophomore year were more likely to encounter dating violence during their junior year than women who did not drink as heavily during their sophomore year.
Given these findings, Stappenbeck and Fromme recommend tailoring education and intervention programs to men and women based on when they may be most vulnerable to heavy drinking and violent relationships. For example, programs should target men before they enter college, and teach them that heavy drinking and dating violence often go hand in hand. Programs should offer men strategies to help reduce both behaviors. Women should participate in drinking prevention programs prior to beginning sophomore year. Both men and women would benefit from better information about how to establish and maintain healthy dating relationships.
Although genetic feedback has been evaluated as an adjunct to smoking cessation interventions, its efficacy for reducing alcohol-related risks is unknown. The current study evaluated the feasibility, acceptability, and efficacy of a web-based alcohol intervention incorporating genetic feedback and risk information specific to ALDH2 genotype. The ALDH2*2 variant is associated with partial protection against alcohol dependence but confers significantly increased risk for alcohol-related cancers as a function of alcohol exposure. Two hundred Asian-American young adults were randomly assigned to receive web-based personalized genetic feedback or attention-control feedback. Genetic feedback included health risk information specific to alcohol-related cancer or alcohol dependence, depending on genotype. Genetic feedback and risk information resulted in significant reductions in 30-day drinking frequency and quantity among participants with the ALDH2*1/*2 genotype. Genetic feedback was rated highly by participants and also showed some effects on theoretical correlates of behavior change. Results provide initial evidence of the feasibility, acceptability, and brief efficacy of web-based genetic feedback for reducing alcohol-related health risks associated with the ALDH2 genotype. Results also highlight the utility of targeting preventive interventions based on genetically-related risk and protective factors and specific environmental exposures.
Many children adversely affected by maternal drinking during pregnancy cannot be identified early in life using current diagnostic criteria for fetal alcohol spectrum disorder (FASD). In the current study, conducted with pregnant rats, researchers examined whether ethanol-induced alterations in placental gene expression may be useful as diagnostic indicators of maternal drinking during pregnancy and as a prognostic indicators of risk for adverse neurobehavioral outcomes in affected offspring. Analyses of more than 28,000 genes revealed that the expression of 304 known genes was altered twofold or greater in placenta from ethanol-consuming pregnant rats compared with controls. Gene expression changes involved proteins associated with central nervous system development; immunological responses; endocrine function; skeletal, cardiovascular, and cartilage development, as well as other effects. These results suggest that the expression of a sufficiently large number of placental genes is altered after moderate drinking during pregnancy to warrant more detailed investigation of the placenta as a biomarker system for maternal drinking during pregnancy and as an early indicator of FASD. Given the accessibility of placentas following child birth, the gene changes identified in this study have the potential to serve as practical biomarkers of prenatal alcohol exposure and/or predictors of FASD in offspring. In addition, the identity of these genes could inform our understanding of alcohol's effects on placental function.