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					                            NIAAA Spectrum
NIAAA Spectrum | Volume 1, Issue 1 | September 2009                                                       http://www.spectrum.niaaa.nih.gov



 FeaTure
                                                                                                    In ThIs Issue
Alcoholism isn’t                                                                                    FeaTures
WhAt it Used to Be                                                                                                                                                                1        Alcoholism Isn’t What
                                                                                                                                                                                           It Used To Be
                                                                                                                                                                                  2        Alcohol “Flush” Signals
“NIAAA’s goal now and for the foreseeable future is to                                                                                                                                     Increased Cancer Risk
                                                                                                                                                                                           Among East Asians
develop and disseminate research-based resources for
each stage of the alcohol use disorder continuum, from                                              CharTICle
                                                                                               Alcohol use disorders surpass other drug use disorders
                                                                                              Among U.S. adults                              2.3 million have




                                                                                                                                                                                3          Alcohol Use Disorders
                                                                                              over the age of 18:




primary prevention to disease management,” according
                                                                                                                                             both an alcohol use
                                                                                                                                             disorder and a drug
                                                                                                                                             use disorder


                                                                                                                15.3 million
                                                                                                                have an



                                                                                                                                                                                           Surpass Drug Use Disorders
                                                                                                                alcohol use
                                                                                                                disorder
                                                                                                                only




to acting NIAAA director Ken Warren, Ph.D.
                                                                                                                                                  1.9 million have a
                                                                                                                                                  drug use disorder
                                                                                                                                                  only




T
                                                                                            Millions more Americans have alcohol use disorders (abuse or dependence) than have
                                                                                            other drug use disorders. Most people who have alcohol use disorders do not have other
                                                                                            drug use disorders, but more than half of people with drug use disorders also have an
                                                                                            alcohol use disorder. (Stinson FS et al., Drug and Alcohol Dependence 80 (2005) 105-116)




        he realization dawned gradually        of Mental Disorders, Fourth Edition                  PhoTo essay
        as researchers analyzed data from      (DSM-IV) of the American Psychiatric
                                                                                                                                                                                 3         How Can a See-Through
        NIAAA’s 2001–2002 National             Association (APA). Published in 1994,
                                                                                                                                                                                           Fish Help Advance Alcohol
Epidemiologic Survey on Alcohol and            DSM-IV recognizes alcohol dependence
                                                                                                                                                                                           Research?
Related Conditions (NESARC). In most           by preoccupation with drinking, impaired
                                               control over drinking, compulsive
persons affected, alcohol dependence
                                               drinking, drinking despite physical or               news From The FIeld
(commonly known as alcoholism) looks
less like Nicolas Cage in Leaving Las          psychological problems caused or made                                                                                            4          Estimating Blood Alcohol
Vegas than it does your party-hardy            worse by drinking, and tolerance and/or                                                                                                     Levels in Children
college roommate or that hard-driving          withdrawal symptoms.
                                                                                                                                                                                 4         Lancet Series Examines
colleague in the next cubicle.                                                                                                                                                             Alcohol’s Impact on
                                               Meanwhile, findings continue to
                                                                                                                                                                                           Global Health
“We knew from the 1991–1992 National           accumulate to challenge past perceptions
                                               of the nature, course, and outcome of                                                                                            5          How Not To Raise a
Longitudinal Alcohol Epidemiologic
                                               alcoholism. Among those findings:                                                                                                           College Binge Drinker
Study that alcohol dependence is most
prevalent among younger adults aged                                                                                                                                               6        “Happyhour” Gene Hints
18 to 29,” says Bridget Grant, Ph.D.,            • Many heavy drinkers do not have                                                                                                         at New Alcohol Treatment
Ph.D., chief of NIAAA’s Laboratory                 alcohol dependence. For example,
                                                                                                                                                                                  6        Young, Tech-Savvy, and
Epidemiology and Biometry. “However, it            even in people who have 5 or more
                                                                                                                                                                                           Drinking Too Much
was not until we examined the NESARC               drinks a day (the equivalent of a
data that we pinpointed age 22 as the              bottle of wine) the rate of developing
mean age of alcohol dependence onset.”             dependence is less than 7 percent                5 QuesTIons wITh...
Subsequent analysis by Ralph Hingson,              per year.
                                                                                                                                                                                       7   Dr. Bridget Grant
Sc.D., director, Division of Epidemiology        • Most persons who develop alcohol
and Prevention Research, showed that               dependence have mild to moderate
nearly half of people who become alcohol           disorder, in which they primarily
dependent do so by age 21 and two-thirds           experience impaired control. For
by age 25.                                         example, they set limits and go over
                                                   them or find it difficult to quit or
The NESARC surveyed more than 43,000               cut down. In general, these people
individuals representative of the U.S. adult       do not have severe alcohol-related
population using questions based on criteria       relationship, health, vocational, or
in the Diagnostic and Statistical Manual           legal problems.
2                                                                                NIAAA Spectrum | Volume 1, Issue 1 | September 2009


      • About 70 percent of affected persons        “These and other recent findings turn on its nih.gov) and inform secondary prevention
        have a single episode of less than          head much of what we thought we knew and primary care screening (http://www.
        4 years. The remainder experience           about alcoholism,” according to Mark niaaa.nih.gov/guide).
        an average of five episodes. Thus, it       Willenbring,        M.D.,
        appears that there are two forms of         director of NIAAA’s
        alcohol dependence: time-limited, and       Division of Treatment
        recurrent or chronic.                       and Recovery Research.        “These and other recent findings
      • Although 22 is the average age when         “As is so often true in       turn on its head much of what we
                                                    medicine, researchers
        alcohol dependence begins, the onset
                                                    have studied the patients
                                                                                  thought we knew about alcoholism.”
        varies from the mid-teens to middle
        age.                                        seen in hospitals and
                                                    clinics most intensively.
      • Twenty       years   after    onset         This can greatly skew understanding of a New criteria to guide clinicians in
        of alcohol dependence, about                disorder, especially in the alcohol field, diagnosis and treatment await decisions by
        three-fourths of individuals are            where most people neither seek nor receive the              DSM-V            committee,
        in full recovery; more than half            treatment and those who seek it do so well expected          about      2012.     Both
        of those who have fully recovered           into the course of disease. Longitudinal, Dr. Grant and Howard Moss, M.D,
        drink at low-risk levels without            general population studies such as associate director for clinical and
        symptoms of alcohol dependence.             the      NESARC          permit     us     to translational research, represent NIAAA
      • About 75 percent of persons who             see the entire disease continuum from before on that committee.
        recover from alcohol dependence do          onset to late-stage disease.”
        so without seeking any kind of help,                                                      “NIAAA’s goal now and for the foreseeable
        including specialty alcohol (rehab)         To Willenbring, these realizations call for future is to develop and disseminate
        programs and Alcoholics Anonymous.          a public health approach that targets at-risk research-based resources for each stage
        Only 13 percent of people with alcohol      drinkers and persons with mild alcohol of the alcohol use disorder continuum,
        dependence ever receive specialty           disorder to prevent or arrest problems from primary prevention to disease
        alcohol treatment.                          before they progress. NIAAA is addressing management,” according to acting NIAAA
                                                    this need with tools to expand risk director Ken Warren, Ph.D. .
                                                    awareness (http://rethinkingdrinking.niaaa.


     FeaTure

    Alcohol “FlUsh” signAls increAsed
    cAncer risk
                        “We estimate that at least 540 million people have this alcohol-related
                        increased risk for esophageal cancer,” said first author Philip J. Brooks,
                        Ph.D., of NIAAA’s Laboratory of Neurogenetics.


    M
               ny people of East Asian descent      “We estimate that at least 540 million         The affected enzyme, known as aldehyde
               possess an enzyme deficiency         people have this alcohol-related increased     dehydrogenase 2 (ALDH2), plays an
               that causes their skin to redden,    risk for esophageal cancer,” said first        important role in alcohol metabolism.
    or flush, when they drink alcohol. Scientists   author Philip J. Brooks, Ph.D., of NIAAA’s     Alcohol is first metabolized into
    from NIAAA and Japan’s Kurihama                 Laboratory of Neurogenetics. “Cancer of        acetaldehyde, a toxic chemical that causes
    Alcohol Center now caution that heavy           the esophagus is particularly deadly, with     DNA damage and has other cancer-
    alcohol consumption greatly increases the       5-year survival rates ranging from 12 to       promoting effects. ALDH2 is the main
    risk for esophageal cancer among such           31 percent throughout the world. We hope       enzyme responsible for breaking down
    individuals, who comprise about 8 percent       that, by raising awareness of this important   acetaldehyde into acetate, a non-toxic
    of the world’s population. Their review of      public health problem, affected individuals    metabolite.
    recent research on this topic appeared in the   who drink will reduce their cancer risk by
     March 24, 2009, issue of PLoS Medicine.        limiting their alcohol consumption.”



                                           National Institute on Alcohol Abuse and Alcoholism
NIAAA Spectrum | Volume 1, Issue 1 | September 2009                                                                                                 3


  East Asians have two main variants of
  the ALDH2 gene: one that produces an
  enzyme with normal activity, and another
                                                   CharTICle
  that results in an inactive enzyme. When
  individuals with the inactive variant drink
                                                            Alcohol use disorders surpass other drug use disorders
  alcohol, acetaldehyde accumulates in the                  Among U.S. adults                             2.3 million have
  body, resulting in facial flushing, nausea,               over the age of 18:                           both an alcohol use
  and rapid heartbeat. For people with                                                                    disorder and a drug
  two copies of the inactive variant, these                                                               use disorder
  symptoms are so severe that they can drink
  very little alcohol. However, individuals
  with only one copy of the inactive variant                                 15.3 million
  can become tolerant to the unpleasant                                      have an
  effects of acetaldehyde, which puts them at                                alcohol use
  risk for alcohol-related esophageal cancer.                                disorder
                                                                             only
  A series of epidemiologic studies by Akira
  Yokoyama and his colleagues in Japan have                                                                    1.9 million have a
  shown that individuals with one copy of                                                                      drug use disorder
  the inactive variant are about 6 to 10 times                                                                 only
                                                         Millions more Americans have alcohol use disorders (abuse or dependence) than have
  more likely to develop esophageal cancer               other drug use disorders. Most people who have alcohol use disorders do not have other
  than are individuals with the fully active             drug use disorders, but more than half of people with drug use disorders also have an
  ALDH2 enzyme who drink comparable                      alcohol use disorder. (Stinson FS et al., Drug and Alcohol Dependence 80 (2005) 105-116)
  amounts of alcohol. Dr. Yokoyama is a co-
  author of the latest report.

  The researchers add that many ALDH2-             PhoTo essay: how Can a see-Through FIsh helP
  deficient university students may have
  their first experiences with heavy
                                                   advanCe alCohol researCh?
  drinking while in college. Therefore, it
  is particularly important for university
  health professionals to be aware of the
  relationship between ALDH2-deficiency,
  facial flushing, and alcohol-related
  cancer risk. Informing ALDH2-deficient
  young people of their risk of esophageal
  cancer from alcohol drinking represents a
  valuable and cost-effective opportunity for
  cancer prevention.

  Dr. Brooks and his colleagues said that a
  clinician can reliably determine whether a
  patient is at risk simply by asking about
  previous episodes of facial flushing after
  drinking alcohol. From this perspective,        Why are zebrafish becoming an increasingly popular research model for exploring
  they noted, the flushing response is a          alcohol’s effects on biology and behavior? For one thing, they have transparent embryos
  clinically useful biomarker of genetic          and even a see-through adult strain that allow researchers to observe the development
  susceptibility to esophageal cancer risk        and function of organ systems in live animals. Additionally, zebrafish have hundreds
  from alcohol. .                                 of offspring that mature within a few months and are relatively inexpensive to keep.
                                                  And importantly, zebrafish share a remarkable number of characteristics with humans,
     The article abstract can be found here:      including extensive overlap in the genetic code; comparable early development processes;
     The alcohol flushing response: An            and similar biochemical pathways in the brain, liver, and other organs. Moreover, when
     unrecognized risk factor for esophageal      exposed to alcohol, zebrafish show changes in locomotion, aggression, and socialization
     cancer from alcohol consumption.             that mimic behavior changes in humans. NIAAA intramural scientists and grantees are
     http://www.plosmedicine.org/article/         making use of this versatile animal model to discover connections between alcohol
     info%3Adoi%2F10.1371%2Fjournal.              exposure and changes in gene function, embryonic development, liver metabolism, nerve
     pmed.1000050                                 cell function and activity, and behavior. .



                                                 http://www.spectrum.niaaa.nih.gov
4                                                                               NIAAA Spectrum | Volume 1, Issue 1 | September 2009



     news From The FIeld

    estimAting Blood Alcohol levels
    in children
                       According to the study’s author, John E. Donovan, Ph.D., the findings
                       suggest that children may experience physical and psychological effects
                       after drinking less than a full drink.


    D
             rink for drink, the average           With the modified equation, researchers        among boys aged 9 to 13 who consume 3
             blood alcohol concentrations          can better determine how to assess child       drinks within 2 hours.
             (BACs) attained by children and       or adolescent binge drinking. NIAAA
    adolescents are much higher than those         defines binge drinking as a pattern of         According to the study’s author, John E.
    seen among college students or adults,         alcohol consumption that brings BAC            Donovan, Ph.D., the findings suggest that
    according to a new study supported by          to .08 grams percent or above, the legal       children may experience physical and
    NIAAA that appeared in the June 2009           limit for driving in all 50 States. For the    psychological effects after drinking less
    issue of Pediatrics.                           typical adult male, this pattern corresponds   than a full drink. Research has shown
                                                   to consuming 5 or more drinks in about 2       that the expectation of experiencing such
    Using previously published health              hours (4 or more drinks for adult females).    effects increases the likelihood of starting
    surveys and scientific reports, researchers    A drink is defined as an alcohol beverage      to drink and of involvement in problem
    derived total body water data and alcohol      that contains 0.6 fluid ounces or 14           drinking in adolescence. .
    elimination rates—key variables in             grams of “pure” alcohol, the approximate
    the BAC equation—for individuals               content in a 12-ounce regular beer,             The article abstract can be found here:
    ranging in age from 9 to 17. With that         5-ounce glass of wine, or 1½ -ounce shot        Estimated blood alcohol concentrations
    information, researchers were able to          of 80-proof distilled spirits.                  for child and adolescent drinking and their
    modify the equation used for estimating                                                        implications for screening instruments.
    BACs in adults to estimate the BACs that       The study determined that girls aged 9 to       http://www.ncbi.nlm.nih.gov/pubmed/1948
    theoretically would result after children      17 can be “legally intoxicated” after having    2748?ordinalpos=3&itool=EntrezSystem2.
    and adolescents consume various numbers        as few as 3 drinks in a 2-hour period.          PEntrez.Pubmed.Pubmed_ResultsPanel.
    of drinks. No alcohol was provided to          Similarly, the study’s authors estimate that    Pubmed_DefaultReportPanel.Pubmed_
    children or adolescents as part of this        a BAC of .08 or higher would also result        RVDocSum
    research.


    news From The FIeld

    lAncet series exAmines Alcohol’s
    impAct on gloBAl heAlth
                         Examines economic costs attributable to alcohol use and alcohol use
                         disorders, the cost-effectiveness of policies and programs to reduce alcohol’s
                         harm, as well as a “call to action” for reducing harm from alcohol.


    I
        n its June 27, 2009, issue, The Lancet     covering the economic costs attributable to    Jürgen Rehm, Ph.D., and colleagues
        published a series of articles on          alcohol use and alcohol use disorders, the     analyzed World Health Organization
        alcohol and global health, specifically    cost-effectiveness of policies and programs    (WHO) data and determined that,
    addressing alcohol’s burden, harm-             to reduce alcohol’s harm, as well as a “call   worldwide, 6.3 percent of deaths in men
    reduction strategies, and actions to address   to action” for reducing harm from alcohol.     and 1.1 percent of deaths in women are
    the issue. The series features three papers                                                   attributable to alcohol. The researchers


                                          National Institute on Alcohol Abuse and Alcoholism
NIAAA Spectrum | Volume 1, Issue 1 | September 2009                                                                                                 5


  lAncet series exAmines Alcohol’s impAct on gloBAl heAlth, contnUed

  also found that alcohol is responsible
                              determined that proven strategies for                               In addition to the articles in the series, this
  for the loss of 4.6 percent of disability-
                              reducing harm include: taxation, drunk-                             issue of The Lancet also includes a study
                                                 driving legislation,                             from David Zaridze, M.D., and co-authors
                                                 bans on advertising,                             showing that alcohol was the cause of more
    Worldwide, 6.3 percent of deaths limiting availability                                        than half of deaths in Russian men between
    in men and 1.1 percent of deaths in of alcohol, and                                           15–54 years from 1990–2001. The study of
                                                 providing help for                               nearly 50,000 adults in three Russian cities
    women are attributable to alcohol.           dangerous drinking.                              contributes to an explanation for the life
                                                                                                  expectancy of 59 years for Russian men
  adjusted life years around the world, and—    In their call to action, Sally Casswell, Ph.D.,   vs. 76 years for men in the UK. .
  in middle- and high-income countries—for      and Thaksaphon Thamarangsi, Ph.D., argue
  the loss of 1 percent of gross domestic       that alcohol-related harm has received
  product.                                      less attention from WHO compared with               The entire series, as well as editorials and
                                                that of illicit drugs and tobacco. They             commentary can be found here: The Lancet
  Also in the series, Peter Anderson, M.D.,     suggest a legally-binding Framework                 Series on Alcohol and Global Health.
  and co-authors review interventions that      Convention on Alcohol Control that                  http://www.thelancet.com/series/alcohol-
  may reduce alcohol-related harm for           would be supported by nongovernmental               and-global-health/
  efficacy and cost-effectiveness. They         organizations in concert with WHO.




   news From The FIeld

  hoW not to rAise A college Binge
  drinker
                   Parental allowance of alcohol consumption in late high school was a
                   significant risk factor for alcohol misuse in college.



  P
        arents who allow their children to      as well as on the students’ drinking habits.      parents had very low limits for what they
        drink alcohol in high school are        Additionally, students answered questions         considered acceptable drinking behavior.
        not protecting their children from      about their own experiences with negative         The findings were true for both males and
  abusing alcohol when they leave the home      effects of alcohol, such as hangovers,            females who participated in the study. .
  for college, report researchers from the      drunken driving, and risky sexual behavior
  Prevention Research and Methodology           as a result of drinking.
  Center at Pennsylvania State University.
  Parental disapproval of drinking, however,    Parental allowance of alcohol consumption           The article abstract can be found here:
  does seem to have a protective effect         in late high school was a significant               The impact of parental modeling and
  against alcohol misuse in college.            risk factor for alcohol misuse and its              permissibility on alcohol use and
                                                consequences in college. “Specifically, it          experienced negative drinking consequences
  The findings, presented by the study’s        appears that the limits parents set for their       in college.
  author, Caitlin Abar, at the annual meeting   teens with regard to alcohol consumption            http://www.ncbi.nlm.nih.gov/pubmed/1939
  of the Society for Prevention Research        are particularly important,” note the               8278?ordinalpos=4&itool=EntrezSystem2.
  were published in the June–July 2009 issue    authors. Teens who were permitted to drink          PEntrez.Pubmed.Pubmed_ResultsPanel.
  of Addictive Behaviors. In this study, the    at fairly high levels were more likely to           Pubmed_DefaultReportPanel.Pubmed_
  researchers surveyed 290 college freshmen     drink heavily in college than their peers           RVDocSum
  on their parents’ attitudes toward alcohol,   who were not allowed to drink, or whose



                                                http://www.spectrum.niaaa.nih.gov
6                                                                                 NIAAA Spectrum | Volume 1, Issue 1 | September 2009



     news From The FIeld

    “hAppyhoUr” gene hints At neW
    Alcohol treAtment
                              Animals with a mutant version of the gene, dubbed “happyhour,” grow
                              increasingly resistant to alcohol’s sedative effects


    A
            class of drugs already approved as      grow more sensitive to alcohol. What’s            that come with alcohol intoxication. Those
            cancer treatments might also help       more, rats given the cancer-fighting drug         questions will be the subject of future
            to beat alcohol addiction. That’s the   spontaneously consumed less alcohol that          investigation. Her team is also exploring
    conclusion of a discovery in flies of a gene,   was freely available to them. Their taste         other new gene candidates that turned up
    dubbed “happyhour,” that has an important       for another rewarding beverage—sugar              in the fly screens. She says that several
    role in controlling the insects’ response to    water—was unaffected.                             of those appear to be tied to the EGFR
    alcohol. The study was published in the                                                           pathway in different ways.
    May 29, 2009, edition of the journal Cell.      Earlier studies have shown that fruit flies are
                                                    a useful tool for unraveling the basis for the    “It’s not yet clear how it all fits together,”
    Animals with a mutant version of the gene       effects of alcohol. Several genes previously      she said. “But the fact that we’ve come, in
    grow increasingly resistant to alcohol’s        identified as playing a role in fruit flies’      an unbiased way, to molecules in the same
    sedative effects, the research shows.           alcohol response hold parallel roles in           pathway is telling us this is really, really
    The researchers report further evidence         mammals. In search of similar genes in the        important.” .
    that the gene normally does its work by         new study, the researchers screened mutant
    blocking the so-called epidermal growth         flies for those less sensitive to ethanol.         The article abstract can be found here:
    factor (EGF) pathway. That EGF pathway          That screen led them to happyhour, a gene          Happyhour, a Ste20 family kinase, implicates
    is best known for its role in cancer, and       closely related to mammalian enzymes               EGFR signaling in ethanol-induced
    drugs designed to inhibit the EGF receptor      known as the Ste20-family kinases of the           behaviors.
    (including erlotinib and gefitinib) are FDA-    GCK-1 subfamily.                                   http://www.ncbi.nlm.nih.gov/pubmed/1946
    approved for the treatment of non-small                                                            4045?ordinalpos=2&itool=EntrezSystem2.
    cell lung cancer.                               Author Ulrike Heberlein, Ph.D., said they          PEntrez.Pubmed.Pubmed_ResultsPanel.
                                                    still don’t know exactly how alcohol exerts        Pubmed_DefaultReportPanel.Pubmed_
    Now, researchers have shown that flies          its influence on the EGFR pathway or how           RVDocSum
    and mice treated with erlotinib also            that leads to the telltale changes in behavior


     news From The FIeld

    yoUng, tech-sAvvy, And drinking
    too mUch
                         “Cyber Millenials,” the Nation’s tech-savvy singles and couples living in
                         fashionable neighborhoods on the urban fringe, have the highest rate of
                         risky levels of alcohol drinking.


    “
        Audience segmentation” refers to             this method to find high-risk drinkers in        August 2009 issue of Alcoholism: Clinical
        categorizing people by their behaviors,     the U.S., leading researchers to a group          & Experimental Research.
        attitudes, opinions, or lifestyles. It is   dubbed the Cyber Millenials: the Nation’s
    widely used in social-marketing efforts. A      tech-savvy singles and couples living in          Researchers used multiple marketing-
    new study from NIAAA researchers uses           fashionable neighborhoods on the urban            research data sources merged with CDC’s
                                                    fringe. Results were published in the             Behavioral Risk Factor Surveillance


                                          National Institute on Alcohol Abuse and Alcoholism
NIAAA Spectrum | Volume 1, Issue 1 | September 2009                                                                                               7

  System database. They performed a
  segmentation analysis of those individuals
  who self-reported consuming 5 or more           5 QuesTIons wITh...
  drinks per drinking episode at least twice
  in the preceding 30 days.                      dr. Bridget grAnt
  “We identified the top-10 audience
  segments in the U.S. that engaged in twice-                            Bridget Grant, Ph.D., Ph.D., is the Chief
  a-month, high-risk drinking,” explained                                of NIAAA’s Laboratory of Epidemiology
  Howard B. Moss, M.D., associate director
  for Clinical and Translational Research at                             and Biometry at NIAAA. She has directed
  NIAAA. “Five of these audience segments                                all national NIAAA surveys since
  were made up of young adults, and five
  were middle-aged individuals. The young                                1988 and most recently the National
  adult segment we called the ‘Cyber                                     Epidemiological Survey on Alcohol and
  Millenials,’ with the highest rate of risky
  levels of alcohol drinking, represented                                Related Conditions (NESARC) since 2001.
  well-educated,       ethnically     mixed,
  technologically sophisticated individuals      In just a few sentences how would you          drinking patterns, design better-targeted
  who live in urban fringe areas on the West     describe the NESARC project?                   treatments, and monitor recovery from
  Coast and Middle Atlantic regions.”            NESARC is a large survey of the U.S. adult     alcohol use disorders in the general
                                                 population addressing all aspects of alcohol   population.
  One of the surprising things about this        use. It includes a long list of questions      NESARC’s data can also track trends in
  group, added Dr. Moss, was that it is one      addressing present and past alcohol            the prevalence of alcohol use disorders
  of the most health-conscious segments of       consumption, alcohol use disorders,            over time; help define the relationship
  American society. “They have a lower-          and use of alcohol treatment services.         between alcohol use disorders and drug
  than-average smoking rate, they go to the      It is also the largest and most ambitious      use, mood and anxiety disorders, and
  gym, they consume organic produce, yet         comorbidity study ever conducted, with         personality disorders; and illustrate
  they binge drink at a level that is clearly    questions related to tobacco and illicit       the trends associated with driving after
  detrimental to their well-being.”              drug use as well as psychiatric disorders      drinking.
                                                 associated with alcohol use disorders.
  “Clinicians tend to be more blasé with
  younger, healthier patients, and might not                                                    Moving forward, are there any new
  even ask them about their level of alcohol     What are the advantages of having such         ways that you would you like to see
  consumption or screen them for alcohol         a large survey size?                           NESARC used—either by different
  problems,” said Dr. Moss. “Since half of       The unprecedented sample size of               types of researchers or for different
  our top-10 high-risk drinking segments         NESARC (n = 43,093) makes it possible          purposes than currently?
  are young adults, clinicians might want to     to achieve stable estimates of even rare
  ‘ratchet up’ their index of suspicion when                                                    Analyses with NESARC data, especially
                                                 conditions. Its oversampling of Blacks,        Wave 1 in combination with Wave 2, have
  these individuals present clinically. Asking   Hispanics, and youth, and the inclusion
  about drinking behavior, giving advice,                                                       only just begun. As more researchers take
                                                 of Hawaii and Alaska residents, provide        advantage of the richness of this data set,
  or conducting a formal brief intervention      enough minority respondents to make it
  might save lives in the short-term, and                                                       more knowledge will be gained. That will
                                                 an ideal vehicle for addressing the critical   help identify risk factors and advance
  reduce the risk of later development of        issue of race and ethnic disparities in
  alcohol-related organ damage or alcohol                                                       treatment interventions in the alcohol field.
                                                 disease prevalence, comorbidity, and
  dependence.” .                                 access to health care services. NESARC         In particular, in addition to the opportunities
                                                 is also a longitudinal survey with its first   already discussed, I would hope that
                                                 wave conducted in 2001–2002 and the            researchers will use NESARC to:
                                                 second wave conducted in 2004–2005.
   The article abstract can be found here:       The 70.9 percent overall response rate is          • Estimate the size, characteristics,
   Characterizing and reaching high-risk         excellent.                                           and     changing     nature      of
   drinkers using audience segmentation.                                                              special populations, including
   http://www.ncbi.nlm.nih.gov/pubmed/1941       Who typically uses the NESARC                        individuals with alcohol use
   3650?ordinalpos=1&itool=EntrezSystem2.        database and what are they looking for?              disorders and others who are
   PEntrez.Pubmed.Pubmed_ResultsPanel.                                                                affected by the use of alcohol;
   Pubmed_DefaultReportPanel.Pubmed_             NESARC’s data have several practical
   RVDocSum                                      uses. It can help us understand high-risk




                                                 http://www.spectrum.niaaa.nih.gov
8                                                                                                                                                                                                   NIAAA Spectrum | Volume 1, Issue 1 | September 2009



              •                          Estimate changes in alcohol use disorders and their associated disabilities
                                         over time, and identify factors associated with the natural history of such
                                         disorders; and
                                                                                                                                                                                                                  abouT us
              •                          Determine the number of individuals receiving alcohol treatment through                                                                                                  NIAAA Spectrum is NIAAA’s first-ever
                                         various programs and services, including those not otherwise represented                                                                                                 webzine. With engaging feature articles,
                                         in surveys of treatment facilities, as well as measuring the unmet need for                                                                                              short news updates, and colorful graphics,
                                         alcohol treatment services and identifying barriers to seeking treatment.                                                                                                NIAAA Spectrum offers accessible and
                                                                                                                                                                                                                  relevant information on NIAAA and the
                                                                                                                                                                                                                  alcohol research field for a wide range of
    Your background is in epidemiology, statistics, and survey research in alcohol. If                                                                                                                            audiences. Each issue includes feature-
    you were not an alcohol researcher, what other career might you have pursued?                                                                                                                                 length stories, news updates from the
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    I would have pursued a veterinary medicine surgical specialty or aspired to be a
                                                                                                                                                                                                                  interview with an NIAAA staff member
    Justice on the U.S. Supreme Court. .
                                                                                                                                                                                                                  or alcohol researcher. NIAAA Spectrum is
                                                                                                                                                                                                                  published three times a year.


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                                                                                                                                                             Publications/AlcoholAlerts)    is    NIAAA’S         http://www.spectrum.niaaa.nih.gov
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         and Alcoholism

                                                            Number 78                                                                  July 2009




       A D EVELOPMENTAL
       P ERSPECTIVE ON
       UNDERAGE ALCOHOL USE
                                                                         and school settings, undergoing puberty, gaining greater
                                                                         independence, and taking on more responsibilities. These
                                                                         milestones may come earlier for some individuals than others,
                                                                         depending on how quickly they mature, but tend to corre­
                                                                                                                                                             quarterly bulletin that disseminates important
                                                                                                                                                             research findings on a single aspect of alcohol
                                                                         spond, in general, to certain ages and developmental stages:

                                                                           • Prenatal: prior to birth
       Dramatic developmental changes unfold as individuals mature
       from birth to childhood, from childhood to adolescence,             • Ages 0–10: childhood
       and from adolescence to early adulthood. These include              • Ages 10–15: early to mid­adolescence
       physiological changes—such as physical growth, brain                • Ages 16–20: late adolescence
       development, and puberty—as well as psychological and               • Ages 21–25: transition to early adulthood




                                                                                                                                                             abuse and alcoholism.
       social changes—such as an evolving sense of self, forming
       more mature relationships with friends, and transitioning         Each stage in development carries risks for alcohol use and
       from middle school to high school.                                its consequences. Studies show that alcohol use typically begins
                                                                         in early adolescence (ages 12–14) (1) and that between ages 12
       Developmental changes factor into underage drinking. For          and 21, rates of alcohol use and binge drinking 1 increase sharply
       example, as a high school student transitions to college, he      before leveling off in the twenties (see figure, page 3) (2).
       or she may experience greater freedom and autonomy, creating
       more opportunities to use alcohol. Underage drinking also
       can influence development, potentially affecting the course       How Developmental Factors
       of a person’s life. For example, alcohol use can interfere with   Influence Drinking and Risk
       school performance and/or negatively affect peer relationships.   for Drinking
       This Alcohol Alert examines the complex relationship between      Researchers are investigating the complex relationship
       underage drinking and development: how developmental              between developmental factors and alcohol use to better
       factors influence drinking, the social and physical conse­        understand how the risks for drinking and alcohol­related
       quences of alcohol use, and how various developmental             problems emerge across development.
       stages can be specifically targeted to design more effective
       measures for preventing or treating underage drinking.            Personality and Behavior. Aspects of personality/temperament
                                                                         and certain behaviors that are evident early in life—often
       Key Stages in Human                                               before children enter elementary school—such as antisocial
       Development                                                       behavior, poor self­regulation, poor self­control, anxiety, a
                                                                         tendency toward depression, and shyness may predict initia­
       As children mature, they achieve key developmental mile­          tion of alcohol use in early adolescence, as well as future heavy
       stones such as changing the way they relate to parents and        use and alcohol use disorders (AUDs) (3,4). Individuals with
       peers, beginning school and moving through different grades       the most persistent personality and behavior problems are
                                                                                         those most likely to experience more chronic
      “Chronic heavy drinking during                                                     and severe forms of AUDs in adulthood (5).

       adolescence has been linked to                                                   Family Dynamics. Family dynamics also factor
                                                                                        into a child’s risk for underage drinking. When
       cognitive deficits and alterations                                               parents respond well to their child’s needs,
                                                                                         1


       in brain activity and structure.”
                                                                                           Binge drinking is defined as consuming five or more drinks in a
                                                                                         row for men and four or more drinks in a row for women. Source:
                                                                                         http://www.collegedrinkingprevention.gov.




                                                                                                                                                             Alcohol Research & Health (http://www.
                                                                                                                                                             niaaa.nih.gov/Publications/AlcoholResearch)
                                                                                                                                                             is NIAAA’s quarterly, peer-reviewed scientific
                                                                                                                                                             journal.




                                                                                                                                                             Rethinking Drinking (http://rethinkingdrinking.
                                                                                                                                                             niaaa.nih.gov) is NIAAA’s newest resources
                                                                                                                                                             where individuals can evaluate their own
                                                                                                                                                             drinking patterns.



                                                                                                                                                             College Drinking—Changing the Culture
                                                                                                                                                             (http://www.CollegeDrinkingPrevention.gov),
                                                                                                                                                             created by NIAAA, is your one-stop resource
                                                                                                                                                             for comprehensive research-based information
                                                                                                                                                             on issues related to alcohol abuse and binge
                                                                                                                                                             drinking among college students.



                                                                                                                                                                        http://www.spectrum.niaaa.nih.gov

				
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