Scientists Can Now Block Heroin, Morphine Addiction

In a major breakthrough, an international team of scientists has proven that addiction to morphine and heroin can be blocked, while at the same time increasing pain relief.

Photp: Jens Langner at http://commons.wikimedia.org/wiki/File:PET-image.jpg

Laboratory studies have shown that the drug (+)-naloxone (pronounced: PLUS nal-OX-own) will selectively block the immune-addiction response.The team from the University of Adelaide and University of Colorado has discovered the key mechanism in the body's immune system that amplifies addiction to opioid drugs.

The results -- which could eventually lead to new co-formulated drugs that assist patients with severe pain, as well as helping heroin users to kick the habit -- will be published August 16 in the Journal of Neuroscience.

"Our studies have shown conclusively that we can block addiction via the immune system of the brain, without targeting the brain's wiring," says the lead author of the study, Dr Mark Hutchinson, ARC Research Fellow in the University of Adelaide's School of Medical Sciences.

"Both the central nervous system and the immune system play important roles in creating addiction, but our studies have shown we only need to block the immune response in the brain to prevent cravings for opioid drugs."

The team has focused its research efforts on the immune receptor known as Toll-Like receptor 4 (TLR4).

"Opioid drugs such as morphine and heroin bind to TLR4 in a similar way to the normal immune response to bacteria. The problem is that TLR4 then acts as an amplifier for addiction," Dr Hutchinson says.

"The drug (+)-naloxone automatically shuts down the addiction. It shuts down the need to take opioids, it cuts out behaviours associated with addiction, and the neurochemistry in the brain changes -- dopamine, which is the chemical important for providing that sense of 'reward' from the drug, is no longer produced."

Senior author Professor Linda Watkins, from the Center for Neuroscience at the University of Colorado Boulder, says: "This work fundamentally changes what we understand about opioids, reward and addiction. We've suspected for some years that TLR4 may be the key to blocking opioid addiction, but now we have the proof.

"The drug that we've used to block addiction, (+)-naloxone, is a non-opioid mirror image drug that was created by Dr Kenner Rice in the 1970s. We believe this will prove extremely useful as a co-formulated drug with morphine, so that patients who require relief for severe pain will not become addicted but still receive pain relief. This has the potential to lead to major advances in patient and palliative care," Professor Watkins says.

The researchers say clinical trials may be possible within the next 18 months.

This study has been funded by the National Institute on Drug Abuse (NIDA) in the United States and the Australian Research Council (ARC).

Source: University of Adelaide (2012, August 14). Scientists can now block heroin, morphine addiction. ScienceDaily. Retrieved April 24, 2013, from http://www.sciencedaily.com­/releases/2012/08/120814213246.htm

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Statistical Model Attempting to Estimate Level of Alcohol Consumption That Is 'Optimal' for Health

Cutting the amount we drink to just over half a unit a day could save 4,600 lives a year in England, according to a modelling study by Oxford University researchers published in the journal BMJ Open.

Half a unit of alcohol is as little as a quarter of a glass of wine, or a quarter of a pint [Credit: © G.G. Lattek / Fotolia]

Scientists have carried out a complex analysis in an attempt to determine the "optimal" level of alcohol consumption that is associated with the lowest rates of chronic disease in the UK. They conclude that the intake of about one-half of a typical drink per day would result in the healthiest outcomes, and the authors conclude that the recommended alcohol intake for the UK should be reduced from the current advised level of drinking.

Half a unit of alcohol is as little as a quarter of a glass of wine, or a quarter of a pint. That's much lower than current government recommendations of between 3 to 4 units a day for men and 2-3 units for women.

The researchers set out to find the optimum daily amount of alcohol that would see fewest deaths across England from a whole range of diseases connected to drink. Previous studies have often looked at the separate effects of alcohol on heart disease, liver disease or cancers in isolation.

'Although there is good evidence that moderate alcohol consumption protects against heart disease, when all of the chronic disease risks are balanced against each other, the optimal consumption level is much lower than many people believe,' says lead author Dr Melanie Nichols of the BHF Health Promotion Research Group in the Department of Public Health at Oxford University.

The team used a mathematical model to assess what impact changing average alcohol consumption would have on deaths from 11 conditions known to be at least partially linked to drink.

These included coronary heart disease, stroke, high blood pressure, diabetes, cirrhosis of the liver, epilepsy, and five cancers. Over 170,000 people in England died from these 11 conditions in 2006, and ill health linked to alcohol is estimated to cost the NHS in England £3.3 billion every year.

The researchers used information from the 2006 General Household Survey on levels of alcohol consumption among adults in England. They combined this with the disease risks for differing levels of alcohol consumption as established in large analyses of published research.

They found that just over half a unit of alcohol a day was the optimal level of consumption among current drinkers.

They calculate this level of drinking would prevent around 4,579 premature deaths, or around 3% of all deaths from the 11 conditions.

The number of deaths from heart disease would increase by 843, but this would be more than offset by around 2,600 fewer cancer deaths and almost 3,000 fewer liver cirrhosis deaths.

'Moderating your alcohol consumption overall, and avoiding heavy-drinking episodes, is one of several things, alongside a healthy diet and regular physical activity, that you can do to reduce your risk of dying early of chronic diseases,' says Dr Nichols.

She adds: 'We are not telling people what to do, we are just giving them the best balanced information about the different health effects of alcohol consumption, so that they can make an informed decision about how much to drink.

'People who justify their drinking with the idea that it is good for heart disease should also consider how alcohol is increasing their risk of other chronic diseases. A couple of pints or a couple of glasses of wine per day is not a healthy option.'

Although this study in BMJ Open did not look at patterns of drinking, Dr Nichols says: 'Regardless of your average intake, if you want to have the best possible health, it is also very important to avoid episodes of heavy drinking ("binge drinking") as there is very clear evidence that this will increase your risks of many diseases, as well as your risk of injuries.'

Source: University of Oxford [June 06, 2012]

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One trait has huge impact on whether alcohol makes you aggressive

Drinking enough alcohol to become intoxicated increases aggression significantly in people who have one particular personality trait, according to new research. But people without that trait don't get any more aggressive when drunk than they would when they're sober. That trait is the ability to consider the future consequences of current actions. 

"People who focus on the here and now, without thinking about the impact on the future, are more aggressive than others when they are sober, but the effect is magnified greatly when they're drunk," said Brad Bushman, lead author of the study and professor of communication and psychology at Ohio State University. 

"If you carefully consider the consequences of your actions, it is unlikely getting drunk is going to make you any more aggressive than you usually are." 

Peter Giancola, professor of psychology, at the University of Kentucky, co-authored the paper with Bushman and led the experiments used in the study. Other co-authors were Dominic Parrott, associate professor of psychology at of Georgia State University and Robert Roth, associate professor of psychiatry, at Dartmouth Medical School. Their results appear online in the Journal of Experimental Social Psychology and will be published in a future print edition. 

Bushman said it makes sense that alcohol would make present-focused people more aggressive. 

"Alcohol has a myopic effect -- it narrows your attention to what is important to you right now. That may be dangerous to someone who already has that tendency to ignore the future consequences of their actions and who is placed in a hostile situation." 

The study involved 495 adults, with an average age of 23, who were social drinkers. Before participating, the participants were screened for any past or present drug, alcohol and psychiatric-related problems. Women were tested to ensure they weren't pregnant. 

All participants completed the "Consideration of Future Consequences scale." They indicated how much they agreed with statements like "I only act to satisfy immediate concerns, figuring the future will take care of itself." Scores on this measure determined how much participants were present-focused or future-focused. 

Half the participants were put in the alcohol group, where they received alcohol mixed with orange juice at a 1:5 ratio. The other half were given orange juice with just a tiny bit of alcohol. The rims of the glasses were also sprayed with alcohol so that they thought they were consuming a full alcoholic beverage. 

Participants in the alcohol group had a mean blood alcohol level of 0.095 just before aggression was measured and 0.105 following, meaning they were legally drunk and that their alcohol levels were rising during the measurement of their aggressive behavior. 

Those in the placebo group had mean blood alcohol levels that didn't exceed 0.015, meaning they had very little alcohol in their systems and were well below standards of intoxication. 

The aggression measure used in this study was developed in 1967 to test aggressiveness through the use of harmless but somewhat painful electric shocks. The researchers measured the participants' threshold to the electric shock pain before the experiment began to ensure that no one received a shock that exceeded what they could take. 

Each of the participants was told that he or she was competing with a same-sex opponent in a computer-based speed reaction test, with the winner delivering an electrical shock to the loser. The winner determined the intensity and the length of the shock delivered to the loser. 

In actuality, there was no opponent. There were 34 trials, and the participant "won" half of them (randomly determined). Each time they "lost," the participants received electric shocks that increased in length and intensity over the course of the trials, and the researchers measured if they retaliated in kind. 

"The participants were led to believe they were dealing with a real jerk who got more and more nasty as the experiment continued," Bushman said. "We tried to mimic what happens in real life, in that the aggression escalated as time went on." 

Results were clear, Bushman said. 

"The less people thought about the future, the more likely they were to retaliate, but especially when they were drunk. People who were present-focused and drunk shocked their opponents longer and harder than anyone else in the study," he said. 

"Alcohol didn't have much effect on the aggressiveness of people who were future-focused." 

Men were more aggressive than women overall, but the effects of alcohol and personality were similar in both sexes. In other words, women who were present-focused were still much more aggressive when drunk than were women who were future-focused, just like men. 

Bushman said the results should serve as a warning to people who live only in the moment without thinking too much about the future. 

"If you're that kind of person, you really should watch your drinking. Combining alcohol with a focus on the present can be a recipe for disaster." 

Source: Ohio State University [December 19, 2011]

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New strain of lab mice mimics human alcohol consumption patterns

A line of laboratory mice developed by a researcher from the School of Science at Indiana University-Purdue University Indianapolis drinks more alcohol than other animal models and consumes it in a fashion similar to humans: choosing alcohol over other options and binge drinking.

Credit: Robin Hutton

Animal models previously available to alcohol abuse and alcoholism researchers do not get as drunk as the new strain, unless alcohol is the only choice of fluids, or alcohol is administered by the experimenter. When given the option, previously bred mouse lines continue to drink water even when they can select alcohol. 

These new mice, selectively bred over 40 generations at the School of Science at IUPUI to prefer alcohol over all other choices, will help researchers explore new aspects of the behavioral and genetic determinants of alcoholism. 

In a study published online ahead of print in the journal Addiction Biology on Nov. 29, senior author Nicholas Grahame, associate professor of psychology in the School of Science at IUPUI, reports on the mice he has bred since 1997. The rodents reach blood-alcohol levels of more than 260 mg/dl of alcohol daily, over three times the equivalent of the human legal driving limit and the approximate consumption level that the severest human alcoholics attain. 

"The free-choice drinking demonstrated by the new mouse line provides a unique opportunity to study the excessive intake that often occurs in alcohol-dependent individuals and to explore the predisposing factors for excessive consumption, as well as the development of physiological, behavioral and toxicological outcomes following alcohol exposure," says Grahame, who is a biopsychologist specializing in alcoholism. 

According to the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, an estimated 17.6 million Americans abuse alcohol or are alcohol dependent. Alcohol abuse and alcoholism can be treated but cannot be cured. 

Mice share 80 percent of their genes with humans, so they are an excellent model to study alcoholism, a disease with a strong genetic component. The risk of developing alcoholism is known to be influenced by lifestyle. Animal models allow researchers to employ methods that they are unable to use in humans.

"This line of high-alcohol-seeking mice should be able to give us a better understanding of the basic brain mechanism involved in alcohol consumption as well as greater insight into the toxic effects on the brain, with the goal of developing therapies," said Grahame, whose research focuses on behavioral genetics and behavioral pharmacology. 

As with humans, the mice become intoxicated when the pace of alcohol consumption is faster than the liver can eliminate it. Typically it takes six or seven hours of continuous alcohol drinking for the new strain of mice to reach the highest levels of intoxication. 

Doctoral candidate Liana M. Matson is a co-author of the study. She has conducted research focusing on when the mice drink and determined that they are nocturnal drinkers. This knowledge enabled the mice's blood-alcohol levels to be tested when at their highest level.

 Undergraduate School of Science students Amy Buckingham and Nick Villalta assisted in the research by measuring intake and blood-alcohol levels in the new strain of high-alcohol-seeking mice. In a related study, they analyzed how drunk the mice became by testing how the animals performed on a balance beam.

Development of the mouse line and the Addiction Biology study, "Pharmacologically Relevant Intake During Chronic, Free-Choice Drinking Rhythms in Selectively Bred High Alcohol-Preferring Mice" were funded by NIAAA and the School of Science at IUPUI. 

Source: Indiana University [December 12, 2011]

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Study IDs new genetic links to impulsivity, alcohol problems in men

Being impulsive can lead us to say things we regret, buy things we really don't need, engage in behaviors that are risky and even develop troublesome addictions. But are different kinds of hastiness and rashness embedded in our DNA? A new study suggests the answer is yes -- especially if you're a man. 

The research, led by University of Nebraska-Lincoln assistant professor of psychology Scott Stoltenberg, found links between impulsivity and a rarely researched gene called NRXN3. The gene plays an important role in brain development and in how neurons function. 

The newly discovered connection, which was more prevalent among men than women in the study, may help explain certain inclinations toward alcohol or drug dependence, Stoltenberg said. 

"Impulsivity is an important underlying mechanism in addiction," he said. "Our finding that NRXN3 is part of the causal pathway toward addiction is an important step in identifying the underlying genetic architecture of this key personality trait." 

For the study, researchers measured impulsivity levels in nearly 450 participants -- 65 percent women, 35 percent men -- via a wide range of tests. Then, they compared those results with DNA samples from each participant. They found that impulsivity was significantly higher in those who regularly used tobacco or who had alcohol or drug problems. 

The results, interestingly, also came down along gender lines. In men, two connections clearly emerged; first, between a particular form of the NRXN3 gene and attentional impulsivity, and second, between another NRXN3 variant and alcohol problems. The connections for women, meanwhile, were much weaker. 

Stoltenberg said the gender-specific results are a rich area for further study. 

"We can't really say what causes these patterns of association to be different in men and women. But our findings will be critical as we continue to improve our understanding of the pathways from specific genes to health-risk behaviors," he said. 

The researchers were interested in impulsivity because the trait can predispose people to any number of behavioral problems -- addictions, behavior control, failing to plan ahead or think through consequences of actions -- and settled on the role of NXRN3 from previous, recent studies. 

While the results add important new evidence to the genetic role in impulsivity and, in turn, its role in substance abuse, researchers were careful to not claim a perfect cause-and-effect relationship. Impulsivity may interact with sensitivity to alcohol, for one example, or anxiety, for another, to create complex pathways to substance use problems in both men and women. 

"If you're working to explain how genes are associated with something like (substance) dependence, you have to connect a lot of dots," Stoltenberg said. "There's a big gap between genes and a substance use disorder. Impulsivity is one factor to such problems -- not the only factor." 

Source: University of Nebraska-Lincoln [November 16, 2011]

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The serotonin system in women's brains is damaged more readily by alcohol

After only four years of problem drinking, a significant decrease in the function of the serotonin system in women's brains can be seen. This is the system that regulates such functions as impulse control and mood. It takes 12 years before a corresponding decrease is seen in men. This is the conclusion of multidisciplinary research carried out at the Department of Psychology and the Sahlgrenska Academy at the University of Gothenburg, Sweden. 

The research group in the multidisciplinary project Gothenburg Alcohol Research Project (GARP) has studied for the first time three of the major neurotransmitter substances in the brain in a single individual. They have studied a group of women and a group of men with alcohol dependence. The results will be published in January 2012 in the journal Alcoholism: Clinical & Experimental Research. 

"We have used what is known as neuroendocrine techniques to show that it is principally the serotonergic system in the brain that is seriously impaired by alcohol. This is the system that regulates impulse control and mood, among other functions", says Kristina Berglund, scientist at the Department of Psychology and representative for the research group. 

Both men and women suffer adverse effects, but the effects arise much more rapidly in women. The results show that the function of women's serotonin system has fallen by 50% after as little as four years with problematic alcohol consumption, while it takes 12 years before the function of men's systems is halved. 

"It is important to note that the damage is just as serious in men and women, but the time courses are different. We still don't know whether the serotonin system can repair itself, but there are research results showing that other damage to the brain can heal after a certain period without alcohol", says Ulf Berggren of the Sahlgrenska Academy, University of Gothenburg.  

Source: University of Gothenburg [November 15, 2011]

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Gene impedes recovery from alcoholism

People who are alcohol-dependent and who also carry a particular variant of a gene run an increased risk of premature death. This is a recent finding from the interdisciplinary research at the Department of Psychology and the Sahlgrenska Academy at the University of Gothenburg, Sweden. 

Researchers in the longitudinal project Goteborg Alcohol Research Project (GARP) have been investigating the dopamine D2 receptor gene and found that a variant of this gene is overrepresented in people with severe alcohol dependency, and that it is linked to a number of different negative consequences that can be of vital significance to the person affected. 

"Our research shows that alcohol-dependent individuals, who are also carriers of this gene variant, run 10 times the risk of dying prematurely, compared with the average population," says Claudia Fahlke, a representative from the research team. 

In a study published recently in the journal Alcohol and Alcoholism (issue 46), the research team shows that this gene variant also appears to be associated with a higher tendency among these individuals to suffer a relapse, even if they have undergone treatment for their alcohol dependency. This may provide one explanation as to the higher mortality rate in people suffering from alcohol dependency, who are carriers of this gene variant. 

"This knowledge emphasises the importance of developing methods for early identifying individuals who are also carriers of this gene variant, since the consequences can be so serious," says Jan Balldin at the Sahlgrenska Academy, University of Gothenburg.  

Source: University of Gothenburg [November 15, 2011]

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Alcoholism is linked to higher rates of general and cancer-related deaths

Alcohol consumption causes approximately four percent of all deaths worldwide and is responsible for roughly five percent of global diseases. A study of alcohol consumption in Tuscany, Italy has found that alcoholics have significantly higher rates of both general and cancer mortality when compared to the general population. 

Results will be published in the February 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View. 

"[We conducted this study of] mortality rates [among] this relatively large group of alcoholics because of our interest in better understanding the risk profile of alcoholism," explained Domenico Palli, head of the Nutritional and Molecular Epidemiology Unit at the Cancer Research and Prevention Institute (ISPO) in Florence, and corresponding author for the study. "The higher number of male alcoholics in our group reflects the distribution of alcohol consumption in the Italian population." 

"There have been other studies of the relationship between alcohol and mortality but not with so many addicted people and particularly those with cancer," added Emanuele Scafato, director of the World Health Organization Collaborating Centre for Research & Health Promotion on Alcohol and Alcohol-Related Problems at the Istituto Superiore di Sanità. "From an epidemiological point of view, this is a unique opportunity to examine health experiences and outcomes due to long-term hazardous and harmful consumption of a toxic and well-known carcinogenic that has resulted in alcohol dependence. This is relevant from a public-health perspective in order to formulate caution messages to the public to increase levels of awareness about the need for a healthier lifestyle and really moderate alcohol consumption." 

Palli and his colleagues gathered data on 2,272 alcoholics (1,467 males, 805 females), predominantly middle-aged, who were treated at the Alcohol Center of Florence during the period of April 1985 through September 2001, for a total of 21,855 person-years. Expected deaths were estimated by using age, gender, and calendar-specific regional mortality rates. 

"Our study has provided strong evidence that alcohol addiction significantly increases the risk of death from several causes in comparison to the general population in a Mediterranean country," said Palli. "The alcoholics seemed to be at greater risk of mortality for specific diseases such as infections, diabetes, diseases of the immunological, nervous, cardiovascular, respiratory, and digestive systems, as well as violent causes. Alcohol's role as a 'dietary' carcinogen emerged quite clearly. The highest risks were found for cancers of the pharynx, oral cavity, liver, and larynx, but also the risk of other cancers – esophagus, rectum, pancreas, female breast – was increased." 

"This research is certainly a step in the right direction in order to foster awareness not only for addicted people but for the general population as well," said Scafato. "It is also important for health professionals to increase levels of valid information and competent actions aimed at prevention, early identification, advice, and helping people change. It is furthermore one more tool for better dealing with a counterproductive and misleading information spread mainly by commercial interests that always give a positive image of drinkers, portraying drinking as a 'must' behavior. Those who are advised or believe that one glass could be good for the heart, they should also be aware that WHO councils that for many people, females and the elderly for example, just a bit more than a glass increases the risk of 60 diseases and 14 cancers. This is what prevention needs to address in terms of informed choices, keeping in mind that hazardous alcohol use always produces more harm than benefits at the population level." 

The results also showed that female alcoholics reported higher survival rates than male alcoholics. "Perhaps female alcoholics are more likely to obtain help and achieve remission, tend to benefit more than men from continued participation in treatment programs, and/or tend to be referred to specific alcohol centre earlier than men, who often are admitted with advanced disease or only when severe symptoms emerge," said Palli. 

"Women usually live longer than males on average," added Scafato, "and are much more keen to control their health status; they also tend to have a higher probability of receiving medical interventions due to a different social networking and mutual gender support. " 

"Clearly alcohol abuse can compromise the structure and functionality of several human organs, thus directly increasing the risk of death," said Palli. "Other aspects of the characteristic life-style of alcoholics – smoking, drug abuse, promiscuity and a poor diet – may contribute to this high-risk pattern together with reduced health-consciousness." 

"These results send a clear message about drinking," said Scafato. "Less is better. Alcohol-related cancer is by definition an avoidable cause of premature mortality, morbidity, and disabilities. It is up to the consumer to adopt a model of consumption that follows existing national guidelines, and respects alcohol-free workplaces, drink/driving laws, and abstaining from alcohol during pregnancy and adolescence. Clinicians and medical doctors should keep in mind the need for early detection of hazardous or harmful consumption. The Alcohol Use Disorders Identification Test is the best option as a general-population level screen." 

Source: Istituto Superiore di Sanita via EurekAlert! [November 15, 2011]

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Under money strains, some older adults may turn to alcohol

During financial hard times, some older adults may turn to alcohol or cigarettes as a way to cope, according to a study in the November issue of the Journal of Studies on Alcohol and Drugs. 

The study, of more than 2,300 older Americans, found that some -- particularly men and people with less education -- were at risk of boosting their drinking if their finances took a hit. 

The same correlation was seen when it came to smoking, especially among relatively younger study participants (those who were age 65 at the study's start). 

The findings do not prove that financial strain, per se, was the reason for the changed drinking and smoking habits. But it is known that some people use alcohol and cigarettes as a way of coping with stress, says lead researcher Benjamin A. Shaw, Ph.D., of the State University of New York at Albany. 

"When you have a stressor that's not very controllable, people may focus on something to help control their emotional response to the stressor," Shaw says. 

And financial woes may be particularly stressful for older adults, he notes. 

"They are out of the workforce, and they might feel like they have less time to recover or generally have less control over their financial situation," Shaw says. 

The older adults in the study were surveyed periodically between 1992 and 2006, when the world was in stronger financial shape than it is now. The ongoing financial crisis, coupled with the aging population, means that the number of older adults facing money problems will probably only grow, Shaw's team says. 

Overall, 16% of study participants reported increasing financial strain over the study period. Three percent reported increases in heavy drinking (more than 30 drinks a month), and 1% said they'd started smoking more. 

Those odds were higher among older men who were under growing financial strain: they were 30% more likely to take up heavy drinking than men who'd remained financially stable. 

The findings were similar when the researchers compared older adults with low education levels (less than high school) with their more-educated counterparts. 

In contrast, older women tended to cut down on drinking when they hit financial hard times -- as did those with higher education levels. 

The reasons for those differences are not clear. But Shaw speculates that older men may tend to have a harder time facing financial woes -- because they are used to being the "breadwinner," for example, or because they tend to have less social support than women do. 

It's also possible that for older generations, drinking and smoking are considered less appropriate responses to stress for women. 

The bottom line, according to Shaw, is that people should be aware that some older adults may respond to financial problems by turning to alcohol or smoking. Older people do often keep money difficulties to themselves, he notes; but if family members know that an older relative is in financial trouble, they can be on the lookout for possible problem drinking or increases in smoking. 

In addition, Shaw says, human service agencies, and even local health departments, could play a role by setting up programs to help older adults find better ways to deal with the stress that originates from experiencing financial difficulties. 

Source: Journal of Studies on Alcohol and Drugs [November 09, 2011]

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Doctors' own alcohol consumption colors advice to patients

Doctors who drink more themselves are more liberal in their advice to patients on alcohol consumption. They set higher thresholds for what is harmful, and while men who are heavy drinkers get to continue drinking, women are often advised to stop altogether, reveals a thesis from the Sahlgrenska Academy at the University of Gothenburg, Sweden. 

Doctors who drink more themselves are more liberal in their advice to patients on alcohol consumption

Researchers at the University of Gothenburg's Sahlgrenska Academy have for the first time looked into how family doctors' own drinking habits affect their advice to patients. The study, which took the form of a questionnaire for doctors in the county of Skaraborg, revealed that those who drink larger amounts set significantly higher limits for harmful levels of consumption than those who are teetotalars or drink little. 

Gender plays a role 

Gender also plays a role in the advice doctors give. Where men and women present with the same health problem and consume comparable amounts of alcohol, male heavy drinkers are often advised to cut down on their drinking, while female heavy drinkers are urged to stop drinking altogether. 

Men less likely to be referred for treatment 

Heavy drinkers are also much less likely to be referred for treatment if they are men than if they are women – especially if the doctor is a man. "Doctors who drink more have a more liberal view of alcohol, but their attitude is also coloured by high consumption among men being the social norm," says Magnus Geirsson, doctoral student at the Unit of Social Medicine at the Sahlgrenska Academy and himself a family doctor in Skaraborg. 

More training, higher limits 

Doctors' alcohol training also plays a role, but perhaps not as one might expect. Nine out of ten doctors in the study set the limit for safe alcohol consumption below the Swedish National Institute of Public Health (FHI) recommendations of 14 units for men and nine for women. Interestingly, doctors who had the most alcohol-related training and considered themselves knowledgeable in the area set higher limits, but they were still below the FHI recommendations. 

Government project made no change 

"This may be because doctors feel that the FHI sets the limits too high, but it could also be that doctors who feel less confident in this area prefer to be more cautious", says Geirsson. 

His thesis also shows that the training activities carried out as part of the government's five-year Risk Drinking Project, which aimed to make alcohol-related issues a natural part of health care, have porobably not led to the desired effects of increasing the numbers of patients being adviced on alcohol, in spite of a considerable increase in the numbers of GPs and nurses that consider themselves to be more skilled in giving such advice. 

Source: University of Gothenburg [October 31, 2011]

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Moderate alcohol consumption is associated with small intestinal bacterial overgrowth

Just one drink per day for women -- two for men -- could lead to small intestinal bacterial overgrowth (SIBO) and subsequently cause gastrointestinal symptoms like bloating, gas, abdominal pain, constipation and diarrhea, according to the results of a new study unveiled today at the American College of Gastroenterology's (ACG) 76th Annual Scientific meeting in Washington, DC. 

The retrospective review, "Moderate Alcohol Consumption is Associated with Small Intestinal Bacterial Overgrowth," looked at the charts of 198 patients who underwent lactulose hydrogen breath testing (LHBT) to determine the presence of SIBO, and found that any current alcohol consumption was significantly associated with the presence of SIBO -- and neither smoking nor use of heartburn drugs called PPIs was associated with an increased risk of SIBO. 

Small intestinal bacterial overgrowth is a condition where abnormally large numbers of bacteria grow in the small intestine. Normally the small intestine contains a relatively low number of bacteria in contrast to the large intestine, which should contain a larger number of bacteria. In patients with SIBO, the abnormally large numbers of bacteria in the small intestine use for their growth many of the nutrients that would otherwise be absorbed. 

As a result, a person with small bowel bacterial overgrowth may not absorb enough nutrients and become malnourished. In addition, the breakdown of nutrients by the bacteria in the small intestines can produce gas as well as lead to a change in bowel habits. 

While previous studies have focused on alcoholics, who were found to have high rates of SIBO, this study by Scott Gabbard, MD and colleagues at the Dartmouth-Hitchcock Medical Center and the Mayo Clinic, is one of the first to look at the relationship between moderate alcohol consumption and SIBO. Moderate alcohol consumption means no more than 1 drink per day for women and 2 drinks per day for men, with twelve ounces of regular beer, 5 ounces of wine, or 1-½ ounces of 80-proof distilled spirits counting as one drink, according to the USDA dietary guidelines. 

An overwhelming majority (95 percent) of the 198 patients in the study drank a moderate amount of alcohol, sometimes less than 1 drink per day, said Dr. Gabbard, who also indicated that only four of the patients drank more alcohol -- a finding he noted indicates that consumption of even the slightest amount of alcohol could have an impact on gut health. 

"These findings are significant because we now know that any bit of alcohol consumption -- not just the amount consumed by alcoholics -- is a strong predictor of a positive lactulose hydrogen breath testing and small intestinal bacterial overgrowth," he said. "While typical treatment for SIBO has been antibiotics, probiotics or a combination of the two, the question now becomes what is the exact association between moderate alcohol consumption and SIBO and whether alcohol cessation can be used as a treatment for this potentially harmful condition." 

Source: American College of Gastroenterology [October 31, 2011]

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