Seizure Drug May Treat Alcoholism

Topiramate has been used to treat alcoholism for a little while now and was featured in the HBO Addiction series. This story has been very widely reported over the last few days. It may become a useful tool for a small number of alcoholics, but I find the results reported in this article pretty underwhelming:

Compared with placebo treatment, treatment with Topamax was associated with an 8 percent greater reduction in the percentage of heavy drinking days during the trial, the researchers reported.

Researcher Bankole Johnson, MD, tells WebMD that alcoholics in the trial who took Topamax went from the equivalent of drinking a bottle and a half of wine a day to about 3 1/2 glasses of wine.

"I think that is a big difference," he says. "Most people can manage that amount of alcohol without getting into too much trouble."

The researchers reported that Topamax users had a greater rate of achieving 28 or more days of continuous nonheavy drinking during the study and 28 days of continuous abstinence.

The manufacturer has also been accused of promoting off-label use:

But in a letter to the FDA, the consumer interest group Public Citizen accused the company of illegally promoting use of the drug for this purpose.

While doctors can legally prescribe FDA-approved drugs for nonapproved conditions, it is illegal for the companies that market the drugs to promote these so-called "off label" uses.

The Public Citizen complaint involved a question-and-answer sheet distributed to the media before publication of the study, which specifically discussed the drug's potential "off label" use for alcohol dependence.

Kara Russell of Ortho-McNeill tells WebMD that the company knew nothing about the question-and-answer sheet until the Public Citizen letter became public."

Ortho-McNeil Neurologics does not support any reference to off label use of its products and only promotes the use of Topamax in the approved indication of migraine and epilepsy treatment," Russell says.

I'm not surprised. I've wondered what arrangement led to the prominent placement of topiramate in the HBO series. It was practically an infomercial and led the lay people I know to grossly overestimate the effectiveness of the drug.




Technorati Tags: topiramate, addiction, alcoholism, treatment, research, medication

Powered by ScribeFire.

Study in rats suggests moderate alcohol consumption improves recall

Moderate alcohol consumption may actually improve memory:

Among the normal rats, the animals that consumed moderate amounts of alcohol fared better on both tests compared with the teetotalers. Rats on a heavy alcohol diet did not do well on object recognition (and, in fact, showed signs of neurotoxicity), but they performed better than their normal brethren on the emotional memory task.

Bad news if you recently experienced something that you don't want to remember too vividly, like trauma:

"People often drink to 'drown sorrows,'" Kalev says. "Our results suggest that this could actually paradoxically promote traumatic memories and lead to further drinking, contributing to the development of alcoholism."

Technorati Tags: alcohol, brain, memory, trauma

Powered by ScribeFire.

How many drinks is too many? | The Daily Telegraph

I've been in a couple discussions over the past few days about federal drinking guidelines and what constitutes risky drinking. It just happens that Australia is reviewing their drinking guidelines. Of special concern are pregnant women and young women. Their drinking guidelines for healthy people between 18 and 64 are as follows:

For men: No more than 4 Standard Drinks a day on average and no more than 6 Standard Drinks on any one day. One or two alcohol-free days per week.

For women: No more than 2 Standard Drinks a day on average and no more than 4 Standard Drinks on any one day. One or two alcohol-free days per week.

*These drinks should be spread over several hours. For example, men should have no more than 2 standard drinks in the first hour and 1 per hour after that. Women should have no more than 1 standard drink per hour.

Special report: Under-age drinking (U.K.)

Independent Online Edition >England is also experiencing problems with underage drinking. In England 18 year olds can purchase alcohol and 16 year olds can drink alcohol in s restaurant, if the alcohol was purchased by a parent.

Amid growing concerns over 24-hour drinking, soaring rates of liver disease and police forces unable to cope with drunken disturbances on the streets, an exclusive Independent on Sunday investigation today reveals the dramatic rise in children admitted to hospital because of alcohol-related illnesses.

The biggest increase is seen among girls under 16 years old, with a 25 per cent increase between 2002/03 and 2004/05. And the problem is getting worse: hospital admissions for under-18s are at their highest since records began, and the average amount children are drinking every week has doubled since 1990.

Professor Mark Bellis, director of the Centre for Public Health at Liverpool John Moores University and a government adviser on alcohol-related issues, said: "The numbers of underage drinkers in hospital for alcohol-related conditions are substantial but it is only the tip of the iceberg. Many more children are admitted for problems not recorded as alcohol. The admissions include everything from being involved in violence to teenage pregnancies. For every one youth admitted due to alcohol consumption there are many more whose health suffers through excessive alcohol consumption."

The ages of children admitted to hospital for alcohol-related problems are getting lower. The number of eight-year-old-boys who drink has doubled from 5 per cent in 1995 to 10 per cent in 2005. The number of 11-year-old girls who drink has increased from 15 per cent in 1995 to 25 per cent in 2005. Many experts believe country is in the grip of a hidden epidemic - one that, like alcoholics themselves, the country is in denial about.

...

Last year police introduced exclusion zones around the beaches of Polzeath and Rock after residents complained of underage drinking and fighting. Dubbed the "Costa del Sloane", the beaches are a magnet for children from public schools.

A senior policeman with Devon and Cornwall constabulary also spoke out about the underage drinking culture after a mob of 100 youths - some as young as 12 - were caught at a mass boozing session in Falmouth.

The startling rise in underage drinking is already beginning to have repercussions on public health and will continue to do so for future generations unless something is done to curb the alcohol consumption of British children, campaigners say.

Frank Soodeen of the charity Alcohol Concern said: "A recent government report on alcohol-related deaths showed that the biggest group was men and women aged 35-54 - which is far younger than ever before. Clearly it's beginning to catch up at an earlier stage, which is very worrying. Generally the highest proportion a few years ago was well above that age group."

The most serious of these health problems is liver cirrhosis. People in their 20s and 30s are now ending up with serious liver problems which, until recently, were normally seen in people twice those ages.

Professor Ian Gilmore, president of the Royal College of Physicians and a liver specialist at the Royal Liverpool Hospital, said: "Cirrhosis of the liver has increased tenfold since the 1970s. There is a big concern about the rise in deaths from cirrhosis among young people. I think we are going to see big increases in people in their 20s and 30s being diagnosed with liver cirrhosis."

David Mayer, chair of the UK Transplant Liver Advisory Group, warned that young drinkers are storing up a problem for the future and are likely to require his services in years to come. "People have more money and more opportunity to drink from an earlier age and therefore their livers are exposed to chronically high alcohol levels. We are concerned that it's becoming an epidemic. It does take many years to develop cirrhosis, but if you start drinking at an early age you are going to see problems sooner rather than later."

With such a marked increase in child drinking, campaigners are furious over the lack of provision offered to young people such as Hayley in helping to tackle their problems. There are even calls for drying-out clinics to be set up specially for young people.

But Professor Bellis argues that we need to help children long before it reaches that stage. "Waiting until children develop alcohol problems means their health, their education and ultimately their life prospects have already begun to suffer. We need a major shift in our national attitudes towards alcohol."

Caroline Flint, the public health minister, last week claimed that the Government is tackling the problem through "targeted enforcement" - reducing sales to under-18s by bars, off-licences and retailers - as well as education on substance abuse.

But campaigners blame the drinks industry for promoting alcohol as "sexy" to the young. Mr Soodeen said: "The drinks industry plays a big part in the whole issue. We really need to be cutting off the supply to young people. Unfortunately, the drinks industry has been very effective in persuading the Government that a 'voluntary health' approach is the way forward. We find it odd that so much of the packaging on alcopops seems juvenile and the alcohol industry has yet to come up with a credible explanation."

[via: Alcohol and Drugs History Society]

An Honest Conversation About Alcohol

From Inside Higher Ed:

Two months after he finished up as president of Middlebury College in 2004, John M. McCardell Jr. wrote a column for The New York Times called “What Your College President Didn’t Tell You.” In the piece, he discussed how he was “as guilty as any of my colleagues [as presidents] of failing to take bold positions on public matters that merit serious debate.” Taking advantage of his new emeritus status, he proceeded to take a few such positions. Among other things, he wrote that the 21-year-old drinking age is “bad social policy and terrible law,” and that it was having a bad impact on both students and colleges....

The current law, McCardell said in an interview Thursday, is a failure that forces college freshmen to hide their drinking — while colleges must simultaneously pretend that they have fixed students’ drinking problems and that students aren’t drinking. McCardell also argued that the law, by making it impossible for a 19-year-old to enjoy two beers over pizza in a restaurant, leads those 19-year-olds to consume instead in closed dorm rooms and fraternity basements where 2 beers are more likely to turn into 10, and no responsible person may be around to offer help or to stop someone from drinking too much.

I have a few brief reactions. First, I don't have a strong opinion on the matter, other than I'd be troubled by 18 year old high-school students being able to buy alcohol.

In principle, the general idea of a less restrictive drinking law might appeal to Libertarians, but drinking licenses? That'll lose Libertarian support fast.

He makes an argument about current law criminalizing parents who try to teach their kids to drink responsibly. First, is serving alcohol necessary to do this? Second, as we saw a few weeks ago, this isn't illegal in 31 states. Third, when is the last time you heard of parents fined or arrested for allowing their teen to have a glass of wine with dinner?

Some of his arguments are a stretch -- for example, using SAMHSA's increased attention to underage drinking as an argument against the existing policy and implying that there's a relationship between the 21 year old drinking law and younger ages of first use.

The fact that we currently have problems, isn't necessarily a good argument against the status quo. Anyone who's honest with themselves will recognize that there is no such thing as a problem-free drug and alcohol policy. As I've said before in this blog, these drug policy questions are all about trade offs and, recognizing that every policy requires living with some problems, the questions you have to wrestle with are:

• Which problems are intolerable and which are you willing to tolerate?
• How do you make these decisions? (I'd suggest that even responses that purport to be value-free are value laden.)
• Which policy (or combination of policies) best balances these values?

It seems like these discussions would generate more light if people were a little more honest in acknowledging the problems inherent in their pet theory.

Teen drinking laws update

A couple of weeks ago I posted about laws that allow teens to drink with their parents and asked for info on Michigan law. Brian, a student of mine who is also a juvenile probation officer sent this:

I checked into the laws governing underage drinking related to parents here at the courthouse. There are no laws that allow for parents to let their kids drink in any circumstance. However, there are limited exceptions. One is allowed for religious purposes in a religious setting. Another is for educational purposes like in a culinary class for cooking. If a parent provides or allows a kid to drink they can be charged with contributing to the delinquency of a minor or furnishing alcohol to a minor.

Thanks Brian!

Charity records 13% rise in post-Christmas abortions

A publicity seeking stunt? Or, a little mentioned harm associated with excessive drinking?

The family planning service Marie Stopes International said today that it performed a record number of UK abortions last month.

The charity carried out nearly 6,000 abortions at its nine centres across the UK in January, the highest number in its 32-year history. This was a rise of 13% on January last year.

The charity's UK director, Liz Davies, blamed the surge in abortions on excess drinking over the Christmas season.

[Hat tip: New Recovery]

Hand sanitizer: a good buzz?

Ethanol -based hand sanitizer will now be contraband in treatment programs, jails and prisons:

Prison officials and poison control centers can add a new substance to their list of intoxicants -- hand sanitizer. A usually calm 49-year-old prisoner prompted a call to the Maryland Poison Control Center after guards found him red-eyed, combative and "lecturing everyone about life." Other inmates and staff reported the unidentified prisoner had been drinking from a gallon container of hand sanitizer, which is more than 70 per cent alcohol, or over 140 proof

Protecting fetuses from mothers who drink

Statin drugs may protect fetuses from maternal alcohol use.

'Drinko': Anatomy of an Advocacy Campaign

Join Together breaks down the campaign that get Target, Kohl's and Linens 'n Things to stop selling drinking games.

Study: H.S. Teenage Binge Drinking Common Link To Greater Risky Behaviors

A new report on the prevalence of teen binge drinking and the harms associated with it:

The latest study published in the January issue of "Pediatrics" based on the Centers for Disease Control (CDC) study indicates that binge drinking is common among high school students and is linked to a greater participation in several other risky behaviors.

The new study conducted by CDC scientists, Binge Drinking and Associated Health Risk Behaviors Among High School Students, found that 45 percent of high school students admittedly reported to alcohol consumption within the last month. The survey found that 64 percent of these students also reported binge drinking.

Binge drinking is defined as consuming five or more alcoholic drinks in a row within a few hours of time.

The study found that the probability of teenage binge drinkers to be tempted to get involved in other risky behaviors was much higher than that of the nondrinking teens.

These risky behaviors included sexual activity, smoking and physical fighting to name a few.

Although those students who denied any binge drinking were involved in many of the other risky behaviors, the extent to which they were involved was much lower than those students who admitted to binge drinking.

According to CDC researcher, Jacqueline Miller, MD, "Our study clearly shows that it's not just that students drink alcohol, but how much they drink that most strongly affects whether they experience other health and social problems."

The CDC researchers indicated the following comparisons between nondrinking and binge drinking teenagers from their study, with teen binge drinkers being:

• Greater than five times more likely to be sexually active with one or more partners.
• Smokers with 19 times more likelihood to smoke cigarettes.
• Almost four times as likely to engage in physical fights.
• Eleven times more likely to become a passenger in a vehicle being driven by another who has been drinking alcohol.
• Almost four times more likely to date rape or a victim of violence by the opposite sex.
• Four times more likely to attempt suicide.
• At greater risk to use drugs, such as marijuana and cocaine.

The survey also indicated that binge drinking among these teenagers was more common with boys than girls.

The binge drinkers self-admittedly reported poorer grades in school as well.

Overall, the survey included reports of both public and private school students across the entire U.S.

Bias in co-occurring research

An interesting new study on drinking and depression:

"Not all studies have found a significant relationship between drinking and depression," said Kathryn Graham, senior scientist at the Centre for Addiction and Mental Health, "and some have found a relationship for one gender but not the other. In our study, we included two quite different types of measures of depression. We also used four clearly different types of alcohol consumption measures that examined both drinking pattern as well as overall consumption." Graham is the corresponding author for the study.

I hate to sound jaded, but when I read this it felt a little like a search for conclusive proof of a strong relationship between the two and self-medication as the probable explanation. I figured I was just too jaded and read on...

Results indicate that measurement and gender are key issues in interpreting findings on the relationship between alcohol and depression. Specifically, depression is primarily related to drinking larger quantities per occasion, is unrelated to drinking frequency, and these effect are stronger for women than for men.

"Depression is most strongly related to a pattern of binge drinking," said Graham. "A pattern of frequent but low quantity drinking is not associated with depression. In fact, those who usually drink less than two drinks per occasion and never drink as much as five drinks are less depressed -- for both measures of depression -- than former drinkers. This relationship with drinking pattern is greater for women than for men."

Second, the overall relationship between depression and alcohol consumption is stronger for women than for men, but only when depression is measured as meeting a clinical diagnosis of major depression. Conversely, there is no gender difference when depression is measured as recent depressed feelings, which is commonly done in research on this topic.

The first conclusion is interesting--it makes a lot of sense that depression would be more strongly associated with heavy drinking episodes rather than the frequency of drinking. The second finding also is not surprising, women self-report depressive symptoms at higher levels then men, and the study is based on a phone survey.

Finally comes the self-medication hypothesis:

"This pattern of associations is more consistent with women using alcohol to counteract depression -- by high-quantity drinking and intoxication -- than with chronic alcohol consumption tending to make women depressed," said Wilsnack. "However, a vicious circle could possibly begin with drinking in response to depression....

The bottom line, said Wilsnack, is that "clinical depression may encourage some women to drink large amounts of alcohol in hopes of numbing depressed feelings, with risks of alcohol abuse and dependence. Therefore, clinicians treating women for depression really need to be concerned about women's use of alcohol, because of the risks that women may try to medicate their moods with alcohol."

This in spite of the fact that the source article itself says "these cross-sectional data do not provide information about temporal ordering or causation".

The impact of alcohol-specific rules, parental norms about early drinking and parental alcohol use on adolescents' drinking behavior

Good news for parents. A new study in the Journal of Child Psychology and Psychiatry and Allied Disciplines finds that alcohol-specific rules and parental alcohol use are related to alcohol use by their children.

Background: The present study explores the role of having rules about alcohol, parental norms about early alcohol use, and parental alcohol use in the development of adolescents' drinking behavior. It is assumed that parental norms and alcohol use affect the rules parents have about alcohol, which in turn prevents alcohol use by adolescent children.

Methods: Longitudinal data collected from 416 families consisting of both parents and two adolescents (aged 13 to 16 years) were used for the analyses.

Results: Results of structural equation modeling show that having clear rules decreases the likelihood of drinking in adolescence. However, longitudinally alcohol-specific rules have only an indirect effect on adolescents' alcohol use, namely through earlier drinking. Analyses focusing on explaining the onset of drinking revealed that having strict rules was related to the postponement of drinking initiation of older and younger adolescents. Further, parental norms about adolescents' early drinking and parental alcohol use were associated with having alcohol-specific rules. Parental norms were also related to adolescents' alcohol use.

Conclusions: The current study is one of the first using a full family design to provide insight into the role of alcohol-specific rules on adolescents' drinking. It was shown that having strict rules is related to postponement of drinking, and that having alcohol-specific rules depends on other factors, thus underlining the complexity of the influence of parenting on the development of adolescents' alcohol use.

Alcohol Policies Really Matter

Timely commentary on alcohol policy from Join Together. It's concise, so I'm posting the whole thing.

Alcohol Policies Really Matter
December 15, 2006

Commentary
By David Rosenbloom

Today we report on the deadly results of Finland's decision to slash alcohol taxes: after two years, alcohol related illness and accidents have replaced heart disease as the leading cause of death among men aged 18 to 65.

There are other national social experiments that are getting similarly bad results. Pubs and bars in England can now stay open almost around the clock. The resulting violence in many town centers, as drunk young men and women spill into the streets, has become a national scandal.

New Zealand lowered its legal drinking age to 18 a few years ago and watched alcohol-related car crashes and deaths among teenagers increase sharply, reversing years of steady decline.

These are sobering reminders that policies about price and availability of alcohol really matter. When the United States raised the minimum drinking age to 21 between 1981 and 1984, there was an immediate drop in deaths from alcohol related accidents in young people; it has stayed near this lower level for 20 years, saving about 1,000 lives a year. The states with the highest beer taxes have significantly lower rates of teenage binge drinking and associated harms than the states with the lowest beer taxes.

Reasonable laws, effectively enforced, save lives. Poor laws -- such as the ridiculously low alcohol taxes in most U.S. states -- cost lives.

I urge all our readers to send Join Together reports about the mistakes in Finland, England and New Zealand to their state and local leaders, reminding them that they have the power to kill or save young people when they adopt new alcohol policies.

David Rosenbloom is the Director of Join Together.

Alcohol Ban Eyed on N.Y. Commuter Rails

I remember as a kid watching men take the train home from NYC with a Q in a brown paper bag. (I suspect that this was more powerful than any ad.) Those days may be coming to an end.

Relapse rates after lung/liver surgery

Two stories about relapse rates following surgery. One about relapse rates following lung cancer surgery:

The U.S. study of 154 smokers who had surgery to remove early stage lung cancer found that, within 12 months after their surgery, 43 percent of them had picked up a cigarette at some point and 37 percent were actively smoking. Sixty percent of patients who started smoking again did so within two months after their operation.

The second reports encouraging numbers about relapse rates following a liver transplant:

During the first year after transplantation, 22% of subjects had at least 1 drink, 10% had at least 1 heavy drinking episode,* and 5% returned to frequent drinking.** By the fifth post-transplant year, 42% had at least 1 drink, 26% had at least 1 heavy drinking episode, and 20% returned to frequent drinking.

Maybe I'm a hypersensitive to stigma, but I wonder is Forbes would have run an article about patient behavior following heart transplants--compliance rates with diet, exercise and medication.

Going for STOP: Congress Passes First Major Underage-Drinking Law

The Sober Truth on Preventing (STOP) Underage Drinking Act made it out of conference and has been passed by the House and Senate.

"Passage of the STOP Act represents a long-overdue acknowledgment of the need to do more as a nation to address the harm caused by underage drinking," said George Hacker, director of the alcohol policies project at the Center for Science in the Public Interest (CSPI), a strong supporter of the bill. "Unlike illicit drugs, there has been no credible national plan to combat alcohol problems, by far the greater health and safety drag on our nation. That is a huge gap that must be filled, and the STOP Act is a step in the right direction."

Major provisions of the STOP Act include a $1-million annual national media campaign on underage drinking; $5 million in grants to help community coalitions address underage drinking; $5 million in grant funding to prevent alcohol abuse at institutions of higher education; requiring the Department of Health and Human Services (HHS) to produce an annual report on state underage-drinking prevention and enforcement activities; establishing a federal interagency coordinating committee on underage drinking; and authorizing $6 million for research on underage drinking.

"Congress has never passed a bill on underage-drinking before," David Jernigan, executive director of the Center on Alcohol Marketing and Youth (CAMY) at Georgetown University, told Join Together. "HHS has never been required to keep an eye on the issue to this extent. The annual report will be a great tool and will keep [underage drinking] from falling off the agenda."

Many facets of the bill were based on the recommendations found in the "Reducing Underage Drinking: A Collective Responsibility" report, released in 2003 by the Institute of Medicine and the National Academy of Sciences.

"Through the hard-hitting public-service ads funded under the measure, parents will get a strong message about the dangers of underage drinking," said Rep. Lucille Roybal-Allard (D-Calif.), the lead sponsor of the measure along with Rep. Tom Osborne (R-Neb.).

Hopefully this will have at least some of the intended effects, however that last paragraph about hard-hitting ads makes me cringe. The feds have a well established pattern of investing heavily in ad campaigns that are ineffective and sometimes associated with increased use. We still know little about how to prevent drug and alcohol problems, so I'd expect mistakes. The problem is that they hide these problems and deny they exist. I'd have no problem with ads if they measure their impact, change as needed and learn from their mistakes. Maybe this campaign will be better because it's not being managed by the ONDCP. We can hope.

Treatment and prevention critic/gadfly Stanton Peele offers his view on the new act.