Trend analysis is important, as long as it accurately captures information that is used to address problems. In the case of alcohol consumption, it appears that the rise in the proportion of drinkers has risen across Whites, Blacks and Hispanics, as well as both genders.

A recent Science Daily release focused on a study conducted by the University Of Texas School Of Public Health in which the importance of examining all groups was highlighted. Different population groups can present varying trends in drinking and problems, making it essential to study all groups.

In this cross-ethnic alcohol trend analysis, alcohol consumption was examined across Whites, Blacks and Hispanics in the United States from 1992 to 2002.

Researchers highlight that Blacks and Hispanics tend to live in communities where alcohol is more available, there is more exposure to outdoor alcohol advertising and where these individuals have been targeted by special advertising. At the same time, they also have access to fewer personal and community resources to respond to such challenges.

In the study, Whites increased their mean number of drinks, whereas Blacks and Hispanics did not show an increase. All three ethnic groups showed a rise in drinking five or more drinks in a day, as well as drinking to intoxication. This rise was limited, however, to those who drank at least once a month.

Drinking trends are linked by factors such as the drinking habits of the individuals within a group. A change in sociodemographic composition can also influence drinking habits.
 

"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.

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.”

Science Daily reports that the researchers argue that some subgroups of South Asians in the UK have a major problem with alcohol and seem to be more susceptible to its effects. Yet the government’s health strategy for alcohol continues to perpetuate the myth that alcohol-related harm is low in all UK South Asians.

The evidence base is limited, wrote Dr. Rashid Zaman and colleagues, but if place of birth is used as a proxy for ethnicity, alcohol-related mortality in England and Wales is about the national average for Eastern European men and women, Sri Lankan men, and East African men, whereas men and women born in the Middle East, North Africa, West Africa, Bangladesh, Pakistan, China, and the West Indies and women born in India, Sri Lanka, and East Africa have lower mortality.

Surprisingly, men born in India reportedly drink less than the general population, yet Indian men have higher rates of alcohol related admission to hospital in England than do British white men.

Dr. Rashid Zaman and colleagues explained that the degree and pattern of alcohol use among UK South Asians varies greatly. Differences in religion, culture, history, and socioeconomic position all play a part, while differences between generations and increased alcohol consumption from acculturation further complicate the picture.

Understanding how these differences interact with biology is the key to making sense of the evidence and developing equitable services to tackle the problem, they say.

Strategies should include outreach workers developing trusted links with the relevant South Asian communities and actively promoting community services, specialist inpatient services, and residential rehabilitation services.

Delivering tailored health messages that are consistent with differing health beliefs and world views would also improve awareness.

The researchers believe the UK’s current health strategy for alcohol is failing a substantial proportion of citizens, and they call for more research to improve our understanding of alcohol-related harm among different ethnic groups.

Science Daily reports that a study of three polymorphisms of the interleukin-1 gene complex (IL-1) and one of the tumor necrosis factor-alpha (TNFα) has found that IL-1 may directly contribute to AD among Spanish Caucasian males.

"Cytokines are proteins which mediate and regulate the inflammatory reaction in infectious and autoimmune diseases," explained Pilar A. Sáiz, associate professor of psychiatry at the University of Oviedo, Spain and corresponding author for the study.

"Clinical observation of increased circulating levels of pro-inflammatory cytokines such as IL-1 and TNFα in patients with alcohol liver disease suggests that they might play a role on the pathogenesis of the disease. Additionally, these cytokines act in the central nervous system affecting the functionality of the serotoninergic and dopaminergic systems, which have been also related to the pathophysiology of AD, and with the brain reward systems involved in alcohol reinforcement."

Sáiz and her colleagues recruited 200 (169 males, 31 females) AD patients from an outpatient detoxification unit, as well as 420 (216 males, 204 females) healthy individuals without a history of drug/alcohol/psychiatric problems (known as "controls"), from the north of Spain. All of the Spanish Caucasian participants were genotyped for four polymorphisms—IL-1α -889 C/T, IL-1ß +3953 C/T, IL-1RA (86bp)n, and TNFα -308A/G—and assessed at baseline and again at six months for alcohol intake, addiction severity, and biomarkers of alcohol intake.

"We found that AD male patients and healthy control male patients differed in the genotype frequencies of the IL-1RA polymorphism owing to an excess of the A1/A1 genotype in the AD males," said Sáiz. "On the other hand, analysis of the IL-1 gene complex revealed a higher frequency of the IL-1a -889C / IL-1b +3953C / IL-1RA A2 haplotype in the control group than among the AD patients, as well as in the abstainers after six months of follow-up compared to the nonabstinent patients."

A haplotype is a combination of alleles at multiple loci that are transmitted together on the same chromosome, Sáiz explained. Prior research has suggested that the study of single polymorphisms may miss more complex haplotype effects, she added.

"In short, this haplotype seemed to exert a protective effect and was related to better outcomes," said Sáiz. "These findings provide further tentative evidence of the role of the IL-1 gene complex in AD as well as evidence that the nature of the associations may be direct, gender-specific, or involve haplotype effects."

She cautioned readers to remember that AD is influenced by both genetic and environmental factors. "We are talking about a multifactorial polygenic disorder caused by a combination of small variations in different genes, often in concert with environmental factors," she said. "In spite of great efforts, the exact genes related to the pathophysiology of alcoholism are yet unknown. Our work represents a small piece of the puzzle."

Researchers from the University of Kansas Medical Center suggest Hispanics with alcohol-induced problems – especially male Mexican Americans – endure significantly worse health and welfare than those from other ethnic groups. This study was featured in Science Daily.

"Problem drinking is particularly bad among male Mexican Americans, which is reflected by a three times higher prevalence rate of past heavy drinking in this population than that reported for non-Hispanic male populations," explained Yu-Jui Yvonne Wan, professor at The University of Kansas Medical Center and corresponding author for the study.

The study evaluated the influence that genes and environment have on alcoholism among Mexican Americans. Findings suggest the interaction between education and a polymorphism of the reward gene contribute to severe alcoholism among this population.

"Hispanics with alcohol-induced problems, such as alcoholic liver disease (ALD), appear to fare significantly less well than those with other ethnic backgrounds,” said Wan. “For example, the survival rate of Hispanic ALD patients after 4.5 years of follow-up is only 28 percent, in contrast to 66 percent for African Americans and 40 percent for Caucasians."

To conduct the study, researchers genotyped two groups of Mexican Americans living in Los Angeles County. One group consisted of 365 alcoholics, while the other group was made up of 338 non-alcoholics or controls.

Overall findings suggest that when an individual received less than or up to 12 years of education, greater drinking levels were observed. This finding implies that when the educational levels of Mexican Americans are improved, there is a potential counteract to the genetic risk factors to help prevent alcoholism.
 

Science Daily reports that a team of researchers, led by scientists at Washington University School of Medicine in St. Louis, studied 6,257 adult twins from Australia to learn whether twins who start drinking at an early age are more likely to develop a heritable form of alcohol dependence than those who begin drinking later in life. The researchers found that the younger an individual was at first drink, the greater the risk for alcohol dependence and the more prominent the role played by genetic factors.

"There seemed to be a greater genetic influence in those who took their first full drink at a younger age," says first author Arpana Agrawal, Ph.D. "That’s very consistent with what has been predicted in the literature and in the classification of types of alcohol dependence, but we present a unique test of the hypothesis."

Agrawal and her colleagues examined previously collected data from identical and fraternal, male and female twins, using statistical methods to measure the extent to which age at first drink changed the role of heritable influences on symptoms of alcohol dependence. Using the twin model, they were able to tease out genetic influences, shared environmental influences, and non-shared environmental factors.

Agrawal’s team found that when twins started drinking early, genetic factors contributed greatly to risk for alcohol dependence, at rates as high as 90 percent in the youngest drinkers. For those who started drinking at older ages, genes explained much less, and environmental factors that make twins different from each other, such as unique life events, gained prominence.

The twins in the study were 24 to 36 years old when they were interviewed, but some reported taking their first drink as young as age 5 or 6. The researchers found that those who were 15 or younger when they started drinking tended to have a greater genetic risk for alcohol dependence. Some who were 16 or older before they took their first drink later became alcohol dependent, but their dependence was related more to environmental factors.

"We don’t have actual gene expression data in this study, but we could hypothesize that exposure to early-onset drinking somehow modifies the developing brain," Agrawal says. "Particularly frequent or heavy early drinking may influence gene expression and contribute to more severe outcomes. Our research cannot prove that, but it’s something that neuro-imaging and gene expression studies certainly should investigate."

Another possibility is that early drinking exposes adolescents to certain environment influences, such as their peer groups, that somehow enhance genetic influences that contribute to risk for alcohol dependence.

"Something about starting to drink at an early age puts young people at risk for later problems associated with drinking," Agrawal says. "We continue to investigate the mechanisms, but encouraging youth to delay their drinking debut may help."

"Some early-onset drinkers do not develop alcohol problems and some late-onset drinkers do—we are working on why that is the case, but it is important to note that this is one risk factor among many and does not determine whether a person will, or will not, develop alcohol dependence," says Agrawal, an assistant professor in the Department of Psychiatry.

"But age at first drink is a well-known risk factor, and there have been two main hypotheses about why: One has been that common genetic and environmental factors contribute both to the risk for alcohol dependence and to the likelihood a person will be younger when consuming their first drink. A second hypothesis suggests starting to drink at a younger age exerts an influence on alcohol dependence that is independent of these shared factors. Our findings suggest there may be some truth to both hypotheses."

Agrawal says studying twins offers advantages when attempting to learn about genetic and environmental influences on alcohol dependence. Since identical twins share 100 percent of their DNA, differences in drinking behavior between a pair of twins must come from environmental factors. Similarities between identical twins tend to be influenced by genes and family environment.

"Particularly identical twins offer us the opportunity to study the perfect natural experiment of genetically identical individuals whose drinking trajectories are modified by their shared and unique life experiences," she explains. "They are important assets in the study of complex behaviors, such as alcohol consumption."

The researchers will develop and test a home-based program designed to promote an alcohol-free childhood, in hopes to reduce the number of children who start using alcohol by sipping on others’ drinks.

"Many parents think that letting children sip drinks will prevent risky drinking during the teenage years," said Christine Jackson, of the Community Health Promotion Research program in the Public Health and Environment division at RTI.

“However, research indicates that this is not the case. Starting alcohol use during childhood, even at very low levels, is strongly associated with habitual alcohol use and high-risk alcohol use during adolescence."

The researchers will follow the participants for four years to see if the children in the program are significantly less likely to being drinking alcohol than those who didn’t participate.

The study is being conducted in collaboration with Susan Ennett, a professor in the School of Public Health at the University of North Carolina at Chapel Hill.
 

While many experts will suggest that there is no specific demographic that is more prone to substance abuse than others, data from this report suggests that there are trends in race and ethnicity use and abuse. This summary will examine those trends, as well as the types of services offered, therapies, sources of referral and employment status and educational level of patients.

Race/Ethnicity

Alcohol was the most commonly mentioned substance at treatment admission for all racial/ethnic groups except for those of Hispanic or Puerto Rican origin. The proportion of individuals reporting use of the next four most common substances – including opiates, marijuana, cocaine and stimulants – showed considerable variance according to racial/ethnic group.

For non-Hispanic Whites, alcohol was reported as the primary substances 44 percent of the time, followed by opiates at 19 percent, marijuana at 13 percent, cocaine at 10 percent and stimulants at 9 percent.

Alcohol was the primary use substance for 32 percent of non-Hispanic Blacks, while 26 percent reported cocaine as their primary use. Marijuana followed closely with 22 percent and opiates were the primary source for 15 percent. Only one percent of those in this ethnic group reported stimulants as their primary substance.

Persons of Mexican origin reported alcohol as the primary substance 36 percent of the time, followed by stimulants at 22 percent. Marijuana was used primarily by 19 percent, with opiates being the primary substance for 14 percent of this demographic. Cocaine was a primary substance for only eight percent of this group.

Individuals of Puerto Rican descent reported opiates as their primary substance 44 percent of the time. Alcohol was a distant second at 27 percent, followed by marijuana at 14 percent and cocaine at 12 percent. Stimulants were reported as a primary substance by only one percent of this demographic.

Alcohol was the primary substance for people of Cuban origin at 37 percent, followed by cocaine and marijuana each at 20 percent. Opiates were reported as the primary substance in 15 percent of cases and stimulants in four percent.
Types of Services

Individuals recorded as TEDS admissions received a variety of services depending upon their reason for admission, level of addiction and primary substance. Of those admitted in 2007, 62 percent entered ambulatory treatment, 20 percent entered detoxification and 18 percent entered rehabilitation/residential treatment.

Ambulatory admissions were largely dominated by primary marijuana users as they made up 83 percent of these admissions. The next largest group was admissions for inhalant use at 69 percent. Detoxification was dominated by primary tranquilizer admissions as 34 percent were admitted for tranquilizers, 33 percent for heroin and 30 percent for alcohol alone.

Rehabilitation/residential treatment received the largest proportion of admissions from primary smoked cocaine users at 32 percent. Admissions for PCP were at 29 percent, hallucinogens at 28 percent, methamphetamine/amphetamines at 26 percent, non-smoked cocaine at 25 percent, and sedatives at 24 percent.

Medication-assisted opioid therapy with methadone or buprenorphine was scheduled for 5 percent of TEDS admissions in 2007. This approach was also planned for 29 percent of primary heroin admissions and for 20 percent of admissions for opiates other than heroin.

Referral Methods

There are a number of sources by which an individual is referred for treatment, the most common method is the through the criminal justice system. In fact, 37 percent of admissions are referred through this process. Of those referred through the criminal justice system, 57 percent were the result of primary marijuana and methamphetamine/amphetamine use and 54 percent for PCP.

Of the TEDS admissions in 2007, 33 percent were self- or individual referrals. Primary heroin users were the most common at 58 percent, followed closely by primary opiate users other than heroin at 52 percent.

Employment Status/Educational Level

Employment status and educational level were also studied among TEDS admissions. In 2007, admissions for alcohol only were the most likely to be employed at 42 percent. The employed proportion was the lowest among those admitted for smoking cocaine and heroin.

The highest proportion not in the labor force was highest among heroin users at 48 percent and lowest for alcohol only at 28 percent. The educational level in 2007 was highest among admissions for sedatives at 33 percent, followed very closely by admissions for alcohol only at 32 percent.