A study from the Loyola University Health System offers evidence that injuries sustained while intoxicated may be more dangerous than previously understood. The researchers found that binge drinking could change the body’s immune system response when orthopedic surgery is performed.

Led by bone biologist John Callaci, PhD, the study was conducted on animal models. It was recently published in the April 20, 2011 edition of the Journal of Bone and Joint Surgery.

Previous research published in the American Journal of Orthopedics showed that a high rate of patients with fractures tested positive for alcohol in their blood and almost a third were shown to be legally drunk. Additional studies have associated alcohol with longer hospital stays and higher infection rates for trauma patients.

After an injury, the immune system produces an inflammatory response. However, in cases of severe injury, the inflammatory response can overwhelm the system and cause organ failure or acute respiratory distress syndrome. When determining when to perform necessary orthopedic surgery, physicians must take into account the levels of the inflammatory response.

The researchers found that in animal models, measuring blood markers of the inflammatory response may be unreliable if the patient has consumed alcohol. When the rats were injected with the equivalent of 2.5 times the legal limit of alcohol for driving and had an injury (in this case, broken legs), the alcohol actually boosted the inflammatory response.

Binge alcohol consumption resulted in contradictory signs of inflammatory response levels. When the researchers tested the chemical markers in the blood, the alcohol seemed to be suppressing the inflammatory response. When the lungs were examined, however, the opposite was found. Alcohol had actually boosted the inflammatory response.

The authors of the study believe that the difference in measurements between the blood and the lungs of intoxicated animals shows that it is possible that alcohol is causing doctors to have a false sense of the inflammatory response in persons that require surgery after binge drinking results in injury.

The research conducted at Loyola University requires further study to determine whether the results can be duplicated in humans, but the results provide a platform for examining the higher risk of elevated inflammatory response after binge drinking.

Foundation director David Crosbie said the decision was at odds with one of the government’s stated priorities in the area of preventative health.

"Alcohol abuse is second only to smoking in the number of preventable deaths caused by substance misuse," he said on Monday, adding it cost the economy more than $15 billion each year.

The Henry review had recommended a volumetric tax on all forms of alcohol, saying social costs of alcohol abuse were not effectively targeted by current tax and subsidy arrangements.

Under the present system, cheap wine is taxed at a much lower rate than other forms of alcohol.

The price of a two liter cask of wine (costing $10.99) includes roughly $1.59 of tax while the same volume of alcohol in full strength beer attracts $7.48 in excise, and in spirits the tax is about $16.45.

"The current system is grossly inequitable," Crosbie said.

Taxation was a powerful evidence-based strategy that was able to impact upon the harmful consumption of alcohol. "In over 50 peer reviewed studies around the world, taxation and price increases have been proven to lower consumption rates."

The government ruled out any immediate changes to taxes on alcohol, pointing to a wine glut and industry restructuring that was under way.

Winemakers predictably applauded the decision, saying any increase in taxes on wine would have devastated the industry amid its toughest period in more than two decades.
Chief of the Winemakers’ Federation of Australia, Stephen Strachan, said taxing wine in the same way as packaged beer would have seen 95 per cent of wine increase in price, sale volumes fall by 34 per cent and about 12,000 jobs lost.

"We don’t deny that alcohol misuse is a problem, but we have to target the causes, not make ordinary Australians pay because we can’t think of any better solutions," he said.

The Associated Press reports that Cambridge Democrat Anthony Galluccio pleaded guilty last month to leaving the scene of an accident that caused minor injuries to a father and his 13-year-old son. As part of his probation, the senator was ordered to abstain from alcohol and to submit to random testing.

Three days after his guilty plea, he tested positive for alcohol during two breath screenings.

Galluccio testified Monday that he had showered and brushed his teeth twice before the testing was done Dec. 21, and insisted he had not ingested any alcohol. He has claimed the positive readings were the result of toothpastes that contain sorbitol, a sugar alcohol and artificial sweetener.

But Judge Matthew Nestor, saying Galluccio ”didn’t last a week” without alcohol, found the lawmaker had violated the terms of his probation. Galluccio, looking stunned, was led away in handcuffs as his mother and sister watched from the courtroom. He will serve his sentence at the Middlesex County jail.

Senate President Therese Murray issued a tersely written comment after Galluccio’s sentencing: ”The senator needs to consider what is in the best interest of his constituents and the Senate.” Murray, D-Plymouth, added that senators will meet Wednesday and take action then, if necessary.

If Galluccio fails to resign, the Senate could refer his case to the Senate Ethics Committee. The committee could then recommend one of four measures: censure or public reprimand; suspension; a call for resignation; or expulsion.

Senate Minority Leader Richard Tisei said Galluccio is no longer able to carry out the duties of his office effectively and ”should realize it is in the best interests of everyone that he resign.”

Plymouth District Attorney Tim Cruz said the judge ”found by clear and convincing evidence” that he violated his probation by drinking alcohol.

”He pleaded out on a Friday and this (failed alcohol screening) happened on a Monday. I don’t think that’s helpful from a defense standpoint,” Cruz said. ”Obviously, there’s a real issue here that needs to be addressed.”

"Caricatures depict acutely intoxicated individuals with a stumbling, weaving, wobbly gait," said Edith V. Sullivan, professor in the department of psychiatry and behavioral sciences at Stanford University School of Medicine and corresponding author for the study.

"With sobriety, gait and balance become stable. However, even with prolonged sobriety, people with long-term chronic alcohol dependence can have difficulty in standing upright. Their balance can be marked by sway that exceeds what most of us experience while standing still in one place, especially with feet together and hands down by one’s side, that is, without use of natural stabilizing factors,” Sullivan continued.

Sullivan said that quantifying the sway can be accomplished by using a force plate to record the sway path in fractions of an inch over fractions of seconds during quiet standing. This provides "sway path tracking" as well as measurement of body tremor, which are micro-movements often reflective of central nervous system damage that can be found both in Parkinson’s disease and alcoholism.

Researchers used a "force platform" to measure postural sway—with and without stabilizing conditions from touch, vision and stance—in 34 alcoholic men, 15 alcoholic women, 22 control men, and 29 control women. They then analyzed "biomechanical control mechanisms" that indicate skeletomuscular control over balance, which (under normal circumstances) means the muscles, joints, and skeletal structure are working synergistically, in a give-and-take manner.

"Results show the sway paths of alcoholics are longer and cover a wider area than those of controls for a given time," said Sullivan. "However, it is important to note that the standing stability of sober alcoholics can be improved by using stabilizing factors. These factors can include simple aids like turning a light on in a dark room, touching a banister while walking down a flight of stairs, or walking or standing with feet apart rather than with ankles close together."

Sullivan added that the disproportionately greater sway in the anterior-posterior (front-to-back) direction than the medial-lateral (side-to-side) direction that they found is associated with chronic alcoholism as well as pathology of the anterior superior vermis of the cerebellum.

"This part of the brain is often disturbed in alcoholism, and lesions there, whether or not a result of alcoholism, can cause impairment in gait and balance," she said. "It is interesting to note that while alcoholic men and women can quell their imbalance with stabilizing factors, alcoholic women do not necessarily improve to control levels."

Until more is known about improving this deficit, Sullivan suggested that people who are at risk utilized simple strategies to stabilize balance and to avoid falls.

"The flies choose to consume alcohol to intoxicating levels, they will do so even if alcohol is made unpalatable, and they relapse to drinking high levels of alcohol after being deprived of it," said Ulrike Heberlein of the University of California, San Francisco. "Addiction is a purely human condition, but, surprisingly, flies show several key features of it."

Heberlein’s group has been studying the genes underlying alcohol response and addiction using flies as a model for many years. (They are the team that earlier this year brought us the "happy hour" gene, which influences flies’ susceptibility to alcohol’s sedative effects.) Heberlein says she is a strong believer that the fly is a useful model of human conditions. Even so, she was "amazed" to find that flies will make such complex decisions when it comes to alcohol.

The researchers found that flies prefer to consume ethanol-containing food over regular food, and that the insects’ preference increases over time. Flies are attracted to the smell of the alcohol, the researchers show, but they actually don’t like its taste. Their attraction to alcohol isn’t explained by the immediate sensory experience of it, or by its calories. Nevertheless, flies self-administer ethanol to intoxicating levels. They will put aside their aversion to particular tastes or smells in order to consume it, and they will rapidly return to high levels of ethanol consumption after a period of imposed abstinence.

Heberlein doesn’t really know in the case of the flies what drives the behavior, but she says she can only assume that they find alcohol rewarding and therefore choose to drink it despite its adverse consequences.

"Previously, we studied simple behaviors, such as intoxication and development of tolerance," Heberlein said. "This work opens the door for us to study much more complex alcohol-related behaviors, such as ‘use despite adverse consequences’ and ‘relapse.’"

The researchers include Anita V. Devineni and Ulrike Heberlein, of the University of California, San Francisco.

Shari Roan of the Los Angeles Times writes that addiction experts now say that many drinkers can evaluate their habits and change those habits if necessary, using new knowledge about genetic and behavioral risks of addiction. Even some people who suffer from alcohol-use disorders can cut back on their consumption before it disrupts their education, ruins careers, and damages health.

Some of the nation’s leading scientists studying substance abuse say that humans travel a long road before they become powerless over alcohol, and most never reach that point.

"We’re on the cusp of some major advances in how we conceptualize alcoholism," says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). "The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence,” he continued.

Many of these people don’t need to give up alcohol altogether. The concept of “controlled drinking”—that people with alcohol-use disorders could simply control their drinking—has existed for many years. Evidence now exists that such an approach is possible for some people, although abstinence is still considered necessary for those with the most severe dependency.

The overall reassessment has been fueled by the groundbreaking National Epidemiologic Survey on Alcohol and Related Conditions, the largest and most comprehensive look at alcohol use in America. The project surveyed 43,000 people 18 and older in 2001 and 2002, and again in 2004 and 2005, with the results released in increments beginning in 2006.

This survey alone has been enough to convince even national addiction experts that they’ve been somewhat narrow in their approach to alcohol disorders. But the findings are being further bolstered by research in genetics and psychology.

Roan writes that alcohol abuse is defined as use that repeatedly contributes, within a 12-month period, to the risk of bodily harm, relationship troubles, problems in meeting obligations, and run-ins with the law. Alcohol dependence includes the same symptoms, plus the inability to limit or stop drinking, the need for more alcohol to get the same effect, the presence of withdrawal symptoms when drinking has stopped, and a consumption level that takes increasing amounts of time.

"For a long time there was an emphasis on alcoholism as if it were one thing," says Carol Prescott, a psychology professor at USC who has studied alcohol-use disorders. "I think that has been abandoned. People with alcohol-related problems don’t all look the same at all. Some people only have problems for a short time. Others develop disorders that are ultimately fatal to them."

The other key finding from the survey is that, at least once in the previous year, 28 percent of adults had exceeded the daily or weekly limits at which drinking is considered low-risk.

For men, low-risk drinking is defined as no more than four drinks on any given day or no more than 14 drinks per week. For women, the limit is three drinks per day or seven drinks per week. (A standard drink is 12 ounces of beer, eight to nine ounces of malt liquor, five ounces of wine, or 1.5 ounces of 80-proof spirits.) The majority of Americans who drink beyond these limits have mild to moderate disorders, meaning they occasionally have trouble controlling their intake, Willenbring says.

That’s where the overall risk assessment comes in. Willenbring compares it to treating high blood pressure or cholesterol before the condition develops into heart disease.

In the national survey, about half of the people who had suffered from an alcohol-use disorder recovered, enabling them to drink at low-risk levels without symptoms of dependence. "Some people are uncomfortable with that," Prescott says. "It’s a safer prescription to tell someone to quit. But the studies suggest that a large proportion of people are able to cut down and aren’t out-of-control."

Other clues can also presage alcohol problems, and should be taken into account when people assess their alcohol consumption:

* Young age at first drink. Perhaps because of changes in the still-developing brain and because they associate with peers who are also heavy drinkers, people who drink at age 15 or younger are at particularly high risk of developing an alcohol problem. The national survey found that nearly half of people who become alcohol-dependent do so by age 21 and 75 percent by age 25.

* Flushing reaction to alcohol. Some people carry a gene mutation (ALDH2) that affects alcohol metabolism and causes them to turn red when they drink. Seen mostly in people of Asian descent, the gene is linked to a higher risk of alcohol-use disorders, but the uncomfortable flushing effect often dissuades these people from drinking.

* Low sensitivity to alcohol. Some people need to drink more to feel an effect compared with the typical person—often referred to as the ability to "drink everyone else under the table." At least five genes are thought to be linked to this proclivity. An estimated 40 percent of children of alcoholics carry this trait.

* Specific gene mutations. They include a mutation of the 5HTT gene, which is linked to low serotonin levels in the brain and is found in 60 percent of people who were alcoholics at age 40, and a mutation of the GABA (A) gene that is linked to a low sensitivity to alcohol.

* The presence of behavioral, emotional,or psychiatric disorders, or smoking dependence.

Any of these factors, when combined with a pattern of exceeding drinking limits, should help people gauge their personal risk, experts say.

Dr. Marc Schuckit is director of the Alcohol and Drug Treatment Program at the Veterans Affairs San Diego Healthcare System, which has revolutionized what is known about genetic influences of alcohol, particularly the concept of low sensitivity. He says genes are responsible for about 60 percent of the risk of alcohol-use disorders and environmental factors account for the other 40 percent—and the two factors conspire to create alcohol-use disorders.

"It’s theoretically possible to take kids before they first drink, find out whether they have any gene variations, and say to them, ‘If you choose to be a drinker, then be careful because it’s very likely that you’ll need to drink more to have the same effect," he says.

Based on the growing knowledge of risk factors, experts at the National Institute on Alcoholism and Alcohol Abuse and other policy-setting health organizations say Americans’ drinking habits should be screened during visits with their primary-care doctor or during emergency room visits.

"From what we know from scientific studies, there are some very clear things that can be done," Willenbring says. "But people don’t ordinarily think of looking to science for how to improve drinking problems."

The ankle bracelet, worn 24/7, samples an offender’s perspiration every 30 minutes in order to measure for alcohol consumption and ensure compliance with court-ordered sobriety and treatment requirements.

The award-winning program was the first veteran-specific court in the country to deal with the unique needs of the ever-increasing number of combat veterans going through the criminal justice system. Under the direction of the Honorable Robert T. Russell, the court aims to link veterans coming through the city’s criminal justice system with a full range of social services, including drug and alcohol treatment, mental health services, medical care, anger management, family counseling, vocation/educational services, and housing.

"Substance abuse, homelessness, unemployment, mental health problems–these issues are found in combination and in alarming numbers with our combat veterans," says Russell. "Ensuring the sobriety of these offenders while we address their issues is essential for long-term success and for helping these men and women get their lives back on track, as well as community safety," he adds.

The National Association of Drug Court Professionals (NADCP) has recently launched a Veterans Treatment Court Clearing House in response to the overwhelming interest in creating a veterans program from courts across the U.S. According to NADCP, there are now 13 Veterans Treatment Courts across the country, and with funding from the Veterans Administration, the number of programs is expected to increase substantially in 2010.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 1.8 million combat veterans meet the criteria for having substance abuse issues. The Bureau of Justice Statistics (BJS) reports that 35 percent of justice-involved veterans suffer from alcohol dependency, and the U.S. Department of Defense reports that the rate of veteran involvement in alcohol-related incidents, including DUI, reckless driving, and drunk and disorderly conduct, more than tripled between 2005 and 2006 alone.

"This isn’t about criminality," says Mike Iiams, chairman and CEO of Denver-based Alcohol Monitoring Systems. "This is about addiction. When these individuals drink, bad things happen, and this program is redefining the way our justice system can change the course of their lives," says Iiams.

The Buffalo Drug and DUI courts have utilized the SCRAM System since 2007, monitoring more than 330 offenders to-date, and the Veterans Treatment Court began using the anklets in December of 2008. AMS donated 10 units to the Buffalo Veterans program in 2008, acknowledging what Iiams calls the "critical importance" of the ground-breaking program. Today, veterans monitored by SCRAM in the Buffalo program pay $6 per day for the monitoring fee, making the program self-sustaining.

SCRAM currently monitors about 10,000 offenders daily and has monitored more than 115,000 offenders in 48 states since it became available in 2003. SCRAM is used to manage and monitor drunk drivers, drug and domestic violence offenders, and underage drinkers. It’s also utilized as a tool in family court, where the determination of custody may be dependent on a participant’s sobriety.

Science Daily reports that this discovery, published in the October 2009 print issue of the journal Genetics, provides a crucial explanation of why some people seem to tolerate alcohol better than others, as well as a potential target for drugs aimed at preventing or eliminating alcoholism. In addition, this discovery sheds new light on many of the negative side effects of drinking, such as liver damage.

"Translational studies, like this one, in which discoveries from model organisms can be applied to insights in human biology, can make us understand the balance between nature and nurture, why we behave the way we do, for better or worse, and what makes us tick," said Robert Anholt, a professor of biology and genetics at North Carolina State University, Director of the W. M. Keck Center for Behavioral Biology, and one of the senior scientists involved in the work.

Anholt and colleagues first measured the amount of time it took for the fruit flies to lose postural control after exposure to alcohol. At the same time, changes in the expression of all the flies’ genes were recorded. Using statistical methods to identify genes that work together, the scientists were able to pinpoint specific genes that played a crucial role in adaptation relating to alcohol exposure. The scientists then set out to determine if the same genes contribute to alcohol drinking habits in humans, and found that the expression of the human counterpart of a critical gene in fruit flies could be directly tied to alcohol consumption in humans.

"From a scientific point-of-view, research like this is almost intoxicating," said Mark Johnston, Editor-in-Chief of the journal Genetics.

"We’ve known for a while now that genetics played a role in alcohol consumption, but now, we actually know some of the genes that are involved. As a result of this work, we have a potential drug target for curing this insidious condition.”

Torres admits he was "killing" himself with drinking in the early 1990s until his bandmates urged him to seek help. He then turned to psychologist Lou Cox, who helped keep the band together after they fired manager Doc McGrath in 1991.

In new film Bon Jovi: When We Were Beautiful, Torres says, "I was the kind of person that wouldn’t drink for months and then blow off two bottles. A lot of that was s**t I had to learn about—my father leaving me when I was a kid…There was a lot of anger behind that.”

"I learned about myself through seeking people…to help me out. I came to grips with that. I met (my father) years later after 20 years…nd I was able to come to terms with that and forgive him…I’m really OK,” he continues.

Jon Bon Jovi says it was inevitable that the band intervened to help Torres. "He had a lot of demons…He was a really bad drunk…T was a very mean, mean man. He’d get you in a lot of trouble with a lot of people."

With Cox’s help, Torres has turned his life around. Bon Jovi adds, "His is the most together life of all of us."

Torres’ past problems gave him the expertise to help Bon Jovi guitarist Richie Sambora when he was struggling with alcohol and prescription pills in 2008.

Torres explains, "The fact that I had four brothers come up to me and say, ‘We care about you’ was big… and it’s the same way I go up to people in the band."

In the new film, Sambora reveals he was initially embarrassed about his dependency on drugs and alcohol. "At first I was ashamed of it…My band and my family picked me up…I’m back to where I used to be."

The Scotsman.com reports that according to the research carried out by the British Society of Gastroenterology, a quarter (26 percent) of Londoners said they drink to calm their nerves, and one in ten said they drink because of depression. But in Wales, 22 percent of those polled said they binge drink while with friends.

Scotland’s most senior police officer said the country’s binge drinking is out of control, and experts estimate that about 100,000 people in the UK could die as a result of alcohol abuse over the next ten years.

Campaigners are calling for better education for young people on the dangers of drinking and urged Scottish politicians to introduce a minimum price for alcohol in Scotland.

Pat Shearer, president of the Association of Chief Police Officers in Scotland and chief constable of Dumfries and Galloway police, said that binge drinking had damaged Scotland’s international image, and called for children as young as five to be educated about alcohol abuse.

"We can’t continue the way we are, the costs are far, far too high,” he said. “Every weekend, we see the extreme impact of binge-drinking, not only on ourselves but also the great demand it places on the health service and the damage it does to families."

Scotland is one of the heaviest drinking countries in Europe, with more than 1,400 alcohol-related deaths last year. Scots are also twice as likely to suffer an alcohol-related death as people in the rest of the United Kingdom.

The charity Alcohol Concern reported that drink-related deaths across the whole of the UK have gone up from 3,054 in 1984 to 8,999 in 2008, so at current consumption levels 90,800 people will die by 2019.

"This is an unacceptably high death toll and the worst part is that all of these deaths are avoidable," said Alcohol Concern chief executive Don Shenker.

The Scottish Government announced plans earlier this year for a new law to bring in a minimum price for alcohol. Health campaigners are urging politicians to ensure that it is sold for at least 40p a unit.

Dr. Evelyn Gillan, director of Scottish Health Action on Alcohol Problems, said: "The evidence suggests that anything less than 40p would not make enough of an impact on people’s habits and so produce the necessary health benefits. You have to have policies that will reduce overall consumption amongst the population and the best way to do that is controls on price."