21 reduces alcohol dependence

More evidence for the argument that lowering drinking ages would lead to more alcohol and drug problems later in life. The point about age of first use vs. regular use is interesting and offers some interesting questions about goals and strategies for prevention programming.

Background: Many studies have found that earlier drinking initiation predicts higher risk of later alcohol and substance use problems, but the causal relationship between age of initiation and later risk of substance use disorder remains unknown.

Method: We use a "natural experiment" study design to compare the 12-month prevalence of Diagnostic and Statistical Manual, Fourth Edition, alcohol and substance use disorders among adult subjects exposed to different minimum legal drinking age laws minimum legal drinking age in the 1970s and 1980s. The sample pools 33,869 respondents born in the United States 1948 to 1970, drawn from 2 nationally representative cross-sectional surveys: the 1991 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001 National Epidemiological Study of Alcohol and Related Conditions. Analyses control for state and birth year fixed effects, age at assessment, alcohol taxes, and other demographic and social background factors.

Results: Adults who had been legally allowed to purchase alcohol before age 21 were more likely to meet criteria for an alcohol use disorder [odds ratio (OR) 1.31, 95% confidence intervals (95% CI) 1.15 to 1.46, p < 0.0001] or another drug use disorder (OR 1.70, 95% CI 1.19 to 2.44, p = 0.003) within the past-year, even among subjects in their 40s and 50s. There were no significant differences in effect estimates by respondent gender, black or Hispanic ethnicity, age, birth cohort, or self-reported age of initiation of regular drinking; furthermore, the effect estimates were little changed by inclusion of age of initiation as a potential mediating variable in the multiple regression models.

Conclusion: Exposure to a lower minimum legal purchase age was associated with a significantly higher risk of a past-year alcohol or other substance use disorder, even among respondents in their 40s or 50s. However, this association does not seem to be explained by age of initiation of drinking, per se. Instead, it seems plausible that frequency or intensity of drinking in late adolescence may have long-term effects on adult substance use patterns.

UPDATE: Oops. Here's the link.

The Sunday ritual

I'm not much of Mitch Albom fan, but good for him. Whether one agrees with him or not, it's something we all take for granted and it deserves discussion.

The video featured two attractive women.

It was shot by an onlooker.

It hit YouTube by storm.

You're no doubt thinking "sex," but let me assure you the women kept their clothes on. Unfortunately, that was the only ladylike thing about them.

On the video, they appeared intoxicated, swore like sailors, got in fights, then screamed, shoved and cursed until security finally took them away, one in handcuffs.

This was not a women's penitentiary. It was a Lions game. You can argue that watching the Lions might make anyone go ballistic. But I'm guessing these women, like many football fans, had another reason for their belligerence:

They were hammered before the game began.

And you could shoot this video every Sunday.

Look, it's bad enough that most NFL games begin at 1 p.m. and that people are buying beers before kickoff. But thanks to tailgating, many fans are blotto before they hand over their tickets. One day, we'll explain to Martians our tradition of arriving hours before a football game, sitting in cold parking lots in fold-up beach chairs, swigging beers and grilling fatty foods between bumpers of pickups (at which point the Martians will bolt to their spaceships).

...

I blame the tailgaters, but I also blame the teams -- pro and college. By encouraging a seven-hour drinking experience, football now sees its stadiums marred with behavior like this past week's wildly popular YouTube moment (billed as "Two Drunk Girls Kicked out of Vikings vs Lions Game").

Cause, effect & underage drinking

Two interesting findings about underage drinking. The first on the relationship between early alcohol use and chronic alcohol problems later in life. The second looks at the relationship between early alcohol use and poor judgment later in life.

We've known for some time that there is a relationship between early drinking and alcohol problems later in life. What's been unclear is the nature of that relationship. Does early exposure to alcohol cause changes in the adolescent brain that lead to problems later in life? Does early exposure facilitate the expression of genes that are related to alcoholism? These two theories would suggest that early exposure to alcohol has the potential to cause alcohol problems later in life. Or, is early exposure an indicator of risk factors such as the environment the young person is in or risk taking behavior? These would suggest that there is no causal relationship.

A new study supports the gene expression theory:

Background: Research suggests that individuals who start drinking at an early age are more likely to subsequently develop alcohol dependence. Twin studies have demonstrated that the liability to age at first drink and to alcohol dependence are influenced by common genetic and environmental factors, however, age at first drink may also environmentally mediate increased risk for alcohol dependence. In this study, we examine whether age at first drink moderates genetic and environmental influences, via gene × environment interactions, on DSM-IV alcohol dependence symptoms.

Methods: Using data on 6,257 adult monozygotic and dizygotic male and female twins from Australia, we examined the extent to which age at first drink (i) increased mean alcohol dependence symptoms and (ii) whether the magnitude of additive genetic, shared, and nonshared environmental influences on alcohol dependence symptoms varied as a function of decreasing age. Twin models were fitted in Mx.

Results: Risk for alcohol dependence symptoms increased with decreasing age at first drink. Heritable influences on alcohol dependence symptoms were considerably larger in those who reported an age at first drink prior to 13 years of age. In those with later onset of alcohol use, variance in alcohol dependence was largely attributable to nonshared environmental variance (and measurement error). This evidence for unmeasured gene × measured environment interaction persisted even when controlling for the genetic influences that overlapped between age at first drink and alcohol dependence symptoms.

Conclusions: Early age at first drink may facilitate the expression of genes associated with vulnerability to alcohol dependence symptoms. This is important to consider, not only from a public health standpoint, but also in future genomic studies of alcohol dependence.

On the second matter, Scientific American [via 3 Quarks Daily] suggests that there is a causal relationship between early exposure to alcohol and poor judgement long after the effects of the alcohol wear off:

It's no secret that binge drinking and faulty decision-making go hand in hand, but what if poor judgment lingered long after putting the bottle down and sobering up? A new study with rats suggests that heavy alcohol consumption in adolescence could put people on the road to risky behavior.

Several studies have associated heavy drinking in youth with impaired judgment in adulthood, but these studies didn't resolve whether alcohol abuse actually predisposes people to develop bad decision-making skills, or if the people who indulged in excessive inebriation were risk-taking types to begin with. As Selena Bartlett, a director in the Ernest Gallo Clinic and Research Center at the University of California, San Francisco, explains, you cannot put adolescents in a room and ask them to consume alcohol to see what happens. But scientists can conduct these kinds of experiments with rats, an animal that Bartlett, who was not part of the study, says is "excellent for modeling changes in behavior" as a result of alcoholism.

In the new study published this week in Proceedings of the National Academy of Sciences, scientists at the University of Washington

(U.W.) in Seattle fed alcohol to a group of rats and found that their ability to make good decisions was impaired even long after they stopped consuming booze.

Frequent Family Dinners May Protect Against Teen Drug Use

Teenagers who eat dinner with their families five times a week are significantly less at risk of alcohol, tobacco or other drug use compared to teens who sit down for family dinner fewer than three times weekly, according to the latest report from the National Center on Addiction and Substance Abuse (CASA*) at Columbia University.

The Importance of Family Dinners V report found that youths who infrequently ate dinner with family members were twice as likely to use alcohol or marijuana and one-and-a-half times more likely to use alcohol. They also were more apt to expect to try using illicit drugs in the future, the survey found.

CASA reported that 59 percent of teens said they had family dinners at least five times weekly, and 62 percent of parents agreed. "The bad news in this year's survey is that work and other activities keep many families from getting to the table for frequent family dinners. But the good news is that most of these teens and parents would be willing to give up a weeknight activity to have dinner with their family," said Joseph A. Califano, Jr., CASA's founder and chairman.

Having distractions at the dinner table, such as talking or texting on the phone or playing video games or surfing the Internet, also correlated with an increased risk of youth alcohol, tobacco and other drug use.

"The magic of the family dinner comes not from the food on the plate but from who's at the table and what's happening there," said Elizabeth Planet, CASA's vice president and director of special projects. "The emotional and social benefits that come from family dinners are priceless. We know that teens who have frequent family dinners are likelier to get A's and B's in school and have excellent relationships with their parents. Having dinner as a family is one of the easiest ways to create routine opportunities for parental engagement and communication, two keys to raising drug-free children."

The report comes on the eve of CASA-sponsored Family Day, Sept. 28, billed as an opportunity for parents to engage with their children in order to prevent the use of alcohol, tobacco and other drugs. Researchers surveyed about 1,000 teens and about 450 parents for the study.

*The National Center on Addiction and Substance Abuse at Columbia University is neither affiliated with, nor sponsored by, the National Court Appointed Special Advocate Association (also known as "CASA”) or any of its member organizations, or any other organizations with the name of "CASA".

(Source: Join Together)

‘Have you done drugs?’ How to answer your kid

How to talk with your kids about drugs:

Communication — talking, listening, and guiding — is the core of parental engagement. You need to be able to talk with your children about difficult issues, including substance abuse, to get them to talk to you honestly about what’s going on in their lives, and to guide them to make healthy, sensible decisions.

But how?

With a teenager especially, how do you connect on a level that is comfortable and natural?

How do you become engaged in your son’s life without making him feel as if you are invading his space? How do you ask questions without making your daughter feel like she’s being interrogated?

How do you talk about substance use (or other risky behaviors) without it turning into a confrontation or a fight? Without getting a “You don’t trust me!” shouted back?

The first step in building good communication is to start early spending quality time just talking to your child — in the car, during dinner, watching TV, going to church, at ball games, walking the dog, playing games, in the park, on vacation — using the moments you have together to get to know your kids and to let your kids get to know you. Talk about anything and everything, it doesn’t matter so much what the subject is as long as you and your children are communicating openly. Your children won’t feel comfortable talking about difficult issues, like drugs and alcohol, if they don’t feel that it’s normal to talk to you about what’s going on in their lives.

With a solid foundation of open, two-way communication, cemented by talking and listening to your child, you will have the Parent Power to guide your child to make the right decisions if your guidance has the ring of authenticity to both of you.

What do I mean by authenticity? Your guidance to your child on making healthy, drug-free decisions and the discussion that accompanies it will have authenticity if they are based on facts and nourished by love.

Read the rest here.