tag:theconversation.com,2011:/fr/topics/alcoholics-2196/articlesAlcoholics – The Conversation2023-10-19T05:11:15Ztag:theconversation.com,2011:article/2159872023-10-19T05:11:15Z2023-10-19T05:11:15ZAdele called herself a ‘borderline alcoholic’. But is that a real thing?<p>British singer-songwriter Adele says she has quit drinking, <a href="https://www.theguardian.com/music/2023/oct/18/adele-says-she-has-quit-drinking-after-being-a-borderline-alcoholic">describing herself</a> as a “borderline alcoholic” when she was in her 20s.</p>
<p>She joins a <a href="https://theconversation.com/why-are-young-people-drinking-less-than-their-parents-generation-did-172225">growing number of people</a> who are trying to quit or reduce their drinking.</p>
<p>But what does “borderline alcoholic” mean and is it a real thing?</p>
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Read more:
<a href="https://theconversation.com/why-are-young-people-drinking-less-than-their-parents-generation-did-172225">Why are young people drinking less than their parents’ generation did?</a>
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<h2>It’s not all-or-nothing any more</h2>
<p>In the <a href="https://theconversation.com/does-alcoholics-anonymous-actually-work-179665">early days</a> of alcohol treatment, people used to think of problems with alcohol as all-or-nothing. They used to believe there was something different about people who had problems with alcohol and those who didn’t. That’s how the idea of the “<a href="https://theconversation.com/is-there-really-such-a-thing-as-an-addictive-personality-184137">addictive personality</a>” came about.</p>
<p>But now we think of drinking on a continuum. It goes from not drinking at all to dependent drinking. And people can move up and down that continuum at different points in their lives. The old saying “once an alcoholic, always an alcoholic” doesn’t apply any more.</p>
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Read more:
<a href="https://theconversation.com/is-there-really-such-a-thing-as-an-addictive-personality-184137">Is there really such a thing as an 'addictive personality'?</a>
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<h2>How much is it OK to drink?</h2>
<p>The Australian national alcohol <a href="https://www.nhmrc.gov.au/health-advice/alcohol">guidelines</a> say healthy men and women should drink no more than ten <a href="https://alcoholthinkagain.com.au/resources-and-tools/standard-drink-tool">standard drinks</a> a week and no more than four a day. So that’s about two to three drinks three to four times a week. <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/alcohol-consumption/latest-release">Most Australians</a> drink within these guidelines.</p>
<p>If you drink over those guidelines you are more likely to experience a number of long- and short-term <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">problems</a> including alcohol dependence, cancers, diabetes and heart disease. The risk of problems increases the more you drink and the more frequently you drink.</p>
<p>About 25% of Australians drink at <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data">risky levels</a> and around 6% drink at such high levels that they would probably be dependent. Daily drinking is associated with dependence.</p>
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<a href="https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Someone with hand over glass of red wine, saying 'no' to a top up" src="https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554657/original/file-20231019-29-3mp7dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">How much do you drink a week, or on any one day?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womans-hand-rejecting-more-alcohol-wine-1840663135">Shutterstock</a></span>
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<h2>So when is someone an alcoholic or a borderline alcoholic?</h2>
<p>The term “alcoholic” is rarely used by health professionals any more. It can make people believe there is nothing they can do about the problems they might be experiencing. Historically, that’s what the early treatment providers believed in the 1930s and that <a href="https://theconversation.com/alcohol-problems-arent-for-life-and-aa-isnt-the-only-option-8-things-film-and-tv-get-wrong-about-drug-and-alcohol-treatment-180946">myth has continued</a>. But some people find identifying as an “alcoholic” helpful to maintain their goal of quitting drinking.</p>
<p>Health professionals have never used the term “borderline alcoholic”. But in describing herself that way Adele is really saying alcohol is having too much of a negative impact on her life, and like many others has decided to do something positive about it by taking a break.</p>
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Read more:
<a href="https://theconversation.com/many-define-adeles-voice-by-its-power-but-the-true-artistry-comes-from-her-fragile-authentic-self-172299">Many define Adele's voice by its power. But the true artistry comes from her fragile, authentic self</a>
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<h2>Which terms do we use now?</h2>
<p>Now, we tend to talk about “dependence” on a continuum from mild to moderate to severe. We also talk about the range of problems other than dependence that people can experience, which also lie on a continuum.</p>
<p>The threshold for whether someone is a problem or dependent drinker is not just how much they drink (although that is important), but also how severe the alcohol-related problems are. </p>
<p>Problems with alcohol don’t always correlate with consumption. Some people can drink a moderate amount and have a lot of problems and others can drink a lot and appear not to have many negative consequences.</p>
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Read more:
<a href="https://theconversation.com/do-different-drinks-make-you-different-drunk-88247">Do different drinks make you different drunk?</a>
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<h2>I’m worried about my drinking. What next?</h2>
<p>If you are wondering if you are drinking too much you can <a href="https://hellosundaymorning.org/nib_alcohol_self-assessment/">check online</a> with a free and anonymous assessment.</p>
<p>Signs you may have a <a href="https://alcoholtreatmentguidelines.com.au/resources/appendix-3-diagnostic-criteria-for-alcohol-dependence">problem with alcohol</a> include:</p>
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<li><p>having trouble stopping once you start drinking</p></li>
<li><p>wanting or trying to cut back but slipping up frequently</p></li>
<li><p>spending a lot of time drinking or recovering from drinking</p></li>
<li><p>having cravings to drink alcohol, such as if you come home from work and reach straight for a drink</p></li>
<li><p>dropping the ball at work, study or home because you’ve been drinking, such as not being able to do your work because you’re hungover</p></li>
<li><p>continuing to drink alcohol even though you know it’s causing problems with your health, friends, work or relationships</p></li>
<li><p>giving up or reducing social and work activities to drink instead</p></li>
<li><p>drinking when it’s not safe, such as before driving or swimming.</p></li>
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Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
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<a href="https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Friends drinking alcohol, clinking glasses, outside" src="https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554656/original/file-20231019-23-d4d6te.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If you cannot quit alcohol like Adele, you can cut down.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheerful-young-friends-toasting-summer-cocktails-1868806051">Shutterstock</a></span>
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<p>If you find you aren’t getting the same effects from alcohol as you used to or you need more and more alcohol to get the same effect, you have probably developed a dependence. </p>
<p>Sometimes people who are very dependent can experience withdrawal symptoms when they stop – strong cravings, nausea, sweating, agitation and anxiety. </p>
<p>The more of these signs you have, the more likely you are to be dependent on alcohol. </p>
<p>If you have any of these signs, taking a break from alcohol for a few months or longer can help. If you find that’s too hard, you can try sticking within the Australian alcohol guidelines by reducing the number of drinks per occasion and increasing your drink-free days.</p>
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Read more:
<a href="https://theconversation.com/trying-to-cut-back-on-alcohol-heres-what-works-179664">Trying to cut back on alcohol? Here's what works</a>
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<h2>There’s help</h2>
<p>Sometimes when people experience some of these problems they need a bit of help to keep them on track. You can talk to your GP who can refer you to a psychologist or treatment service. Or you can try self-help options such as the Hello Sunday Morning’s <a href="https://hellosundaymorning.org/daybreak/">Daybreak app</a> (a community of people supporting each other to change their relationship with alcohol). If your problems are more severe, you can try something like <a href="https://smartrecoveryaustralia.com.au">SMART Recovery</a> (evidence-based group support for alcohol and other drug problems).</p>
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<p><em>If you are worried about your own or someone else’s alcohol or other drug use, you can contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice.</em></p><img src="https://counter.theconversation.com/content/215987/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee is CEO at Hello Sunday Morning and also works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p>Adele is really saying alcohol is have too much of a negative impact on her life, and like many others has decided to do something positive about it by taking a break.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1961062023-01-06T13:30:39Z2023-01-06T13:30:39ZAlcohol use is widely accepted in the US, but even moderate consumption is associated with many harmful effects<figure><img src="https://images.theconversation.com/files/501999/original/file-20221219-26-6hbnxe.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research increasingly shows that the dangers of alcohol have been downplayed and its benefits exaggerated.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/an-elderly-man-abuses-alcohol-royalty-free-image/1175893790">Nes/E+ via Getty Images</a></span></figcaption></figure><p><a href="https://theconversation.com/el-consumo-de-alcohol-esta-ampliamente-aceptado-en-estados-unidos-pero-incluso-el-consumo-moderado-esta-asociado-a-numerosos-efectos-nocivos-201655">Leer en español.</a></p>
<p>This month, millions of Americans are taking part in “<a href="https://www.today.com/health/dry-january-what-it-what-are-benefits-women-t146331">Dry January</a>” in an effort to forgo alcohol for a month and cleanse themselves of the excesses of the holiday season.</p>
<p>Alcohol is the <a href="https://www.globaldrugsurvey.com/">most widely used drug</a> in the world, including in the U.S.</p>
<p>In 2020, nearly 70% of people ages 18 and older in the U.S. said they had consumed an alcoholic drink <a href="https://www.samhsa.gov/data/report/2020-nsduh-detailed-tables">in the previous year</a>, according to the National Survey on Drug Use and Health. Additionally, 24% of people reported binge drinking – defined for women as four or more drinks per occasion and five or more drinks per occasion for men – in the previous month. </p>
<p>The COVID-19 pandemic brought with it important changes in alcohol consumption. One nationally representative sample found that while the number of people who reported drinking in the past year remained consistent from 2019 to 2021, the number of people <a href="https://doi.org/10.1111/acer.14839">consuming alcohol every day increased from 6.3% to 9.6%</a>.</p>
<p>Partially because alcohol is such a commonly used substance, heavily marketed and glamorized in pop culture, Americans’ comfort with and acceptance of its use in everyday life is remarkably high. But should it be? </p>
<p><a href="https://www.sph.pitt.edu/directory/christina-mair">I research alcohol use</a> and the associations between drinking and a wide range of problems. While the <a href="https://www.cdc.gov/opioids/basics/epidemic.html">rising opioid epidemic</a> has received a lot of attention in recent years, the number of deaths attributable to alcohol each year is on par with the overall number of annual deaths from <a href="https://www.cdc.gov/nchs/products/databriefs/db457.htm">drug overdose</a>, with both increasing rapidly in the past few years. </p>
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<figcaption><span class="caption">Having even one drink a day can have a negative effect on your health.</span></figcaption>
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<h2>What about moderate drinking?</h2>
<p>In the past two decades, the idea that moderate drinking may actually confer health benefits <a href="https://doi.org/10.2337/diacare.28.3.719">has taken hold</a>, backed up by <a href="https://doi.org/10.1136/bmj.319.7224.1523">some preliminary and limited evidence</a>. This led to the broad notion <a href="http://www.health.com/health/article/0,,20410287,00.html">in the popular media</a> that a glass of red wine a day reduces the risk of cardiovascular disease and diabetes. </p>
<p>But there was one major flaw in many of the studies used to back up the claim that a glass of red wine is good for health. They compared those who drink at moderate levels to people who consume no alcohol whatsoever, rather than comparing those who drink heavily versus at lower levels. </p>
<p>There are many reasons why people who drink at moderate levels may be fundamentally different – and healthier – than those who do not drink at all. For example, many people who develop new illnesses unrelated to their alcohol use quit drinking, making the group of alcohol abstainers <a href="https://doi.org/10.1093/aje/kwn093">appear less healthy</a> than those who consume alcohol at low or moderate levels. </p>
<p>In 2018, the National Institutes of Health initiated a large randomized control trial – the gold standard for understanding causal relationships – to look into the <a href="https://www.nytimes.com/2017/07/03/well/eat/alcohol-national-institutes-of-health-clinical-trial.html">benefits of moderate drinking</a>.</p>
<p>That trial was designed to pick up the heart benefits of consuming one drink a day, but was not going to be able to detect the negative consequences of moderate alcohol use, such as <a href="https://www.nytimes.com/2018/06/18/health/nih-alcohol-study.html">increases in breast cancer</a>. Because of its inability to <a href="https://doi.org/10.1136/bmj.k3888">pick up on known alcohol-related harms</a> and concerns that the study was co-funded by the alcohol industry, the trial was <a href="https://clinicaltrials.gov/ct2/show/study/NCT03169530">halted after a few months</a>. </p>
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<figcaption><span class="caption">A landmark 2022 study found that even low levels of alcohol consumption can be dangerous.</span></figcaption>
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<h2>Alcohol’s link to cancer and other harms</h2>
<p>Thanks to lobbying by <a href="https://doi.org/10.1111%2Fadd.13048">the powerful</a> <a href="https://doi.org/10.1371/journal.pone.0170366">alcohol industry</a>, alcohol’s dangers may be underplayed and its benefits exaggerated. There are many <a href="https://doi.org/10.1016/j.ypmed.2003.11.027">well-established problems with drinking even at moderate levels</a> that likely outweigh any potential benefits. </p>
<p>Alcohol is the <a href="https://doi.org/10.1001/jama.291.10.1238">third-leading cause of premature death</a> in the U.S. and one of the leading <a href="https://doi.org/10.3389/fpubh.2020.00279">modifiable causes of death worldwide</a>, while receiving some of the least media and policy attention. Worryingly, the number of deaths attributed to alcohol increased by 25% between 2019 and 2020 – a faster rate of increase than for the percentage increase in all deaths – 17% – in the <a href="https://doi.org/10.1001/jama.2022.4308">first year of the COVID-19 pandemic</a>. These rates increased most rapidly among people ages 25 to 44.</p>
<p>The lifetime prevalence of alcohol use disorder – defined as an impaired ability to stop or control alcohol use despite <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder">adverse social, occupational or health consequences</a> – is nearly 30%. In other words, nearly a third of the population has been severely impacted by their drinking at some point in their lifetime.</p>
<p>Alcohol use, even at low levels, is linked to a number of cancers, including <a href="https://doi.org/10.1001/jama.2011.1590">breast</a>, <a href="https://doi.org/10.1093/annonc/mds337">colorectal, liver and esophagus</a>. Alcohol contributes to approximately <a href="https://doi.org/10.1016/j.canep.2021.101893">75,000 cancer cases and 19,000 cancer deaths per year</a>. Furthermore, a recent study found that more than 50% of adults in the U.S. are unaware of the <a href="https://doi.org/10.1158/1055-9965.EPI-22-0420">cancer-related risks of alcohol consumption</a>.</p>
<p>Alcohol also causes a number of serious harms to others, many of them violence-related. These include increased <a href="https://doi.org/10.1016/j.chiabu.2014.03.011">risk of child maltreatment</a>, physical abuse, intimate partner violence, <a href="https://doi.org/10.15288%2Fjsas.2002.s14.118">sexual assaults</a> and <a href="https://doi.org/10.1111%2Fj.1530-0277.2009.00912.x">gun violence</a>. Alcohol-involved traffic fatalities in the U.S. – after several decades of decreasing – <a href="https://www.nhtsa.gov/risky-driving/drunk-driving#">ticked up by 14% to 11,654 in 2020</a>.</p>
<h2>Disparities in alcohol-related consequences</h2>
<p>The effects of alcohol are not felt equally by all: The most vulnerable among us suffer the greatest consequences. In the U.S., Black and Latino people who drink experience a greater number of social consequences from drinking than white people who drink, <a href="https://doi.org/10.1111%2Fj.1530-0277.2008.00880.x">particularly among groups who consume alcohol at low levels</a>. These consequences include arguments or fights, accidents and workplace, legal and health problems.</p>
<p>In addition, studies show that adolescents who report minority sexual orientation tend to <a href="https://doi.org/10.1001/archpedi.162.11.1071">start drinking at younger ages</a> and continue to <a href="https://doi.org/10.1016/j.amepre.2013.11.010">binge drink more frequently as adults</a>. These differences in alcohol-related problems at the same level of alcohol consumption contribute to disparities in many other health outcomes for these populations.</p>
<h2>Raising taxes and drinking age could offset harms</h2>
<p>There are a number of things the U.S. could do to reduce the burden of alcohol consumption through public policy. One proven effective policy includes increasing <a href="https://www.irs.gov/businesses/small-businesses-self-employed/excise-tax">alcohol excise taxes</a>, which are selective sales taxes on the purchase of alcohol. Other policies that have been shown to be effective include restrictions on the number of stores that sell alcohol, restrictions on <a href="https://doi.org/10.1016/j.amepre.2013.03.008">hours of sale</a> and <a href="https://doi.org/10.1162/REST_a_00615">increases in the minimum legal drinking age</a> from 18 to 21. While the current minimum drinking age in the U.S. is 21, prior to 1984 the minimum drinking age <a href="https://www.cdc.gov/alcohol/fact-sheets/minimum-legal-drinking-age.htm#">varied from state to state</a>, with some states allowing drinking as early as age 18.</p>
<p>While the alcohol industry often stands against many of these policies and regulations, they are relatively easy to implement. Despite this, in the U.S., alcohol control policies have been in decline over the past several decades, with many states moving to <a href="https://doi.org/10.1111/add.16003">privatize alcohol sales</a> – in direct opposition to what experts know can reduce alcohol-related harms. Privitization, which <a href="https://doi.org/10.1016/j.amepre.2012.01.002">removes state monopolies on alcohol sales</a>, greatly increases per capita alcohol sales and consumption.</p>
<p>Although alcohol plays a pivotal role in American culture, in my view the undisputed consequences of drinking make it unwise to recommend alcohol as a path to better health and well-being. As I see it, the small reductions in cardiovascular disease that are questionably linked to low levels of consumption are hardly offset by the sizable harms of alcohol on individual and population health.</p>
<p><em>This is an updated version of an article <a href="https://theconversation.com/alcohols-health-benefits-hard-to-prove-but-harms-are-easy-to-document-98813">originally published on July 9, 2018</a>.</em></p><img src="https://counter.theconversation.com/content/196106/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christina Mair receives funding from the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism</span></em></p>The number of deaths related to alcohol use in the US grew by a staggering 25% between 2019 and 2020, the first year of the COVID-19 pandemic.Christina Mair, Associate Professor of Behavioral and Community Health Sciences, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1791762022-04-20T12:17:46Z2022-04-20T12:17:46ZBeer and spirits have more detrimental effects on the waistline and on cardiovascular disease risk than red or white wine<figure><img src="https://images.theconversation.com/files/458683/original/file-20220419-15105-khdsoe.jpg?ixlib=rb-1.1.0&rect=20%2C61%2C6869%2C2623&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are working to tease apart how various alcohol types contribute to weight gain and disease risk.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/six-drinks-royalty-free-image/157333486?adppopup=true">pixhook/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Drinking beer and spirits is linked to elevated levels of <a href="https://doi.org/10.1259/bjr/38447238">visceral fat</a> – the harmful type of fat that is associated with an increased risk of cardiovascular disease, metabolic syndrome, and other health complications – whereas drinking wine shows no such association with levels of this harmful fat and may even be protective against it, depending on the type of wine consumed. In fact, we found that drinking red wine is linked to having lower levels of visceral fat. These are some of the key takeaways of <a href="https://doi.org/10.1002/osp4.598">a new study</a> that my colleagues and I recently published in the Obesity Science & Practice journal. </p>
<p>Although white wine consumption did not influence levels of visceral fat, our study did show that drinking white wine in moderation might offer its own unique health benefit for older adults: denser bones. We found higher bone mineral density among older adults who drank white wine in moderation in our study. And we did not find this same link between beer or red wine consumption and bone mineral density.</p>
<p>Our study relied on a large-scale longitudinal database called <a href="https://www.ukbiobank.ac.uk/">the U.K. Biobank</a>. We assessed 1,869 white adults ranging in age from 40 to 79 years who reported demographic, alcohol, dietary and lifestyle factors via a touchscreen questionnaire. Next, we collected height, weight and blood samples from each participant and obtained body composition information using a direct measure of body composition called <a href="https://radiology.ucsf.edu/blog/dxadexa-beats-bmi-using-x-ray-exam-measure-body-composition-fat-loss">dual-energy X-ray absorptiometry</a>. Then, we used a statistical program to examine the relationships among the types of alcoholic beverages and body composition. </p>
<h2>Why it matters</h2>
<p>Aging is often accompanied by an increase in the problematic fat that can lead to heightened cardiovascular disease risk as well as by a <a href="https://doi.org/10.1177/1759720X11430858">reduction in bone mineral density</a>. This has important health implications given that nearly 75% of adults in the U.S. <a href="https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/overweight-obesity-adults-H.pdf">are considered overweight or obese</a>. Having higher levels of body fat has been consistently linked to an increased risk for acquiring many different diseases, including <a href="https://doi.org/10.1161/CIR.0000000000000973">cardiovascular disease</a>, <a href="https://doi.org/10.1056/NEJMoa021423">certain types of cancer</a>, and <a href="https://doi.org/10.1056/NEJMoa0801891">a higher risk of death</a>. And it’s worth noting that national medical care costs associated with treating obesity-related diseases total more than <a href="https://doi.org/10.18553/jmcp.2021.20410">US$260.6 billion annually</a>.</p>
<p>Considering these trends, it is vital for researchers like us to examine all the potential contributors to weight gain so that we can determine how to combat the problem. Alcohol has long been considered one possible driving factor <a href="https://doi.org/10.1007/s13679-014-0129-4">for the obesity epidemic</a>. Yet the public often hears conflicting information about the potential <a href="https://doi.org/10.1111/psyp.12134">risks</a> and <a href="https://doi.org/10.1016/j.mayocp.2013.11.005">benefits</a> of alcohol. Therefore, we hoped to help untangle some of these factors through our research. </p>
<h2>What still isn’t known</h2>
<p>There are many biological and environmental factors that contribute to being overweight or obese. <a href="https://doi.org/10.1007/s13679-014-0129-4">Alcohol consumption</a> may be one factor, although there are <a href="https://doi.org/10.1111/j.1753-4887.2011.00403.x">other studies</a> that have not found clear links between weight gain and alcohol consumption. </p>
<p>One reason for the inconsistencies in the literature could stem from the fact that much of the previous research has traditionally treated alcohol as a single entity rather than separately measuring the effects of beer, cider, red wine, white wine, Champagne and spirits. Yet, even when broken down in this way, the research yields mixed messages.</p>
<p>For example, <a href="https://doi.org/10.1093/oxfordjournals.aje.a117556">one study has suggested</a> that drinking more beer contributes to a higher waist-to-hip ratio, while <a href="https://pubmed.ncbi.nlm.nih.gov/17416040/">another study</a> concluded that, after one month of drinking moderate levels of beer, healthy adults did not experience any significant weight gain.</p>
<p>As a result, we’ve aimed to further tease out the unique risks and benefits that are associated with each alcohol type. Our next steps will be to examine how diet – including alcohol consumption – could influence diseases of the brain and cognition in older adults with <a href="https://www.nia.nih.gov/health/what-mild-cognitive-impairment">mild cognitive impairment</a>. </p>
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<p class="fine-print"><em><span>Brittany Larsen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research has been inconclusive on the degree to which drinking alcohol leads to the growth of harmful fat. But a new study suggests that beer and spirits are far bigger culprits than wine.Brittany Larsen, Ph.D. Candidate in Neuroscience & Graduate Assistant, Iowa State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1581212021-04-07T12:29:38Z2021-04-07T12:29:38ZMisunderstanding addiction breeds despair and suffering – and, for alleged Atlanta shooter, violence<figure><img src="https://images.theconversation.com/files/393262/original/file-20210402-15-hrcyx0.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C4031%2C2661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A makeshift memorial to the victims of the Atlanta spa shooting shows both grief and outrage.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/MassageParlorShooting/bd69e0bbb92d45cb83dc1f050b912276/photo">AP Photo/Candice Choi</a></span></figcaption></figure><p>When a man claiming to suffer from the disease of sex addiction found that “<a href="https://hopequestgroup.org/treatment-programs/trek/">comprehensive and fully integrated treatment</a>” at a Christian recovery center could not cure him, he decided to try another approach: <a href="https://www.gpb.org/news/2021/03/17/police-suspect-charged-in-massage-parlor-deaths-planned-kill-more">eliminating the women</a> he believed were a “temptation” aggravating his problem.</p>
<p>That’s the <a href="https://www.nytimes.com/2021/03/18/us/robert-aaron-long-atlanta-spa-shooting.html">best understanding so far</a> of what drove Robert Aaron Long to <a href="https://www.cbsnews.com/live-updates/atlanta-shootings-robert-long-murder-8-counts/">allegedly murder eight women</a>, including six of Asian descent, in Atlanta, Georgia on March 16, 2021.</p>
<p>To me as a <a href="https://people.clas.ufl.edu/ttravis/">cultural historian of addiction and recovery</a>, his story highlights the two most common ways Americans think about and deal with compulsive behaviors. We like to consider them the results of temptation or treat them as diseases. </p>
<p>Although these two approaches are often treated as opposites, both stem from the most prominent effort to fight compulsion in U.S. history: the grassroots movement to ban alcohol, which led to <a href="https://www.history.com/topics/roaring-twenties/prohibition">national Prohibition from 1920 to 1933</a>.</p>
<p>The disease concept of addiction arose in the aftermath of Prohibition, in part as a way to explain why the national alcohol ban didn’t actually get rid of alcohol or its abuse. Far from being a biomedical truth, it is <a href="https://psychcongress.com/article/disease-concept-addiction-revisited">just a way of framing compulsive drinking</a>. The story of the alleged Atlanta shooter shows how well the disease concept succeeded as a public relations tool – and also how limited it is as a means of explaining human behavior.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woodcut illustration of a group of women outside a bar, where two men lean against the doorway" src="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393267/original/file-20210402-13-14a7vig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women were prominent leaders and members of the temperance movement, and used various tactics, including singing hymns outside bars.</span>
<span class="attribution"><a class="source" href="https://picryl.com/media/the-ohio-whiskey-war-the-ladies-of-logan-singing-hymns-in-front-of-barrooms">Frank Leslie's illustrated newspaper, 1874, via Picryl</a></span>
</figcaption>
</figure>
<h2>A brief history of Prohibition</h2>
<p>Beginning in the early 19th century, a broad cross-section of Americans – <a href="https://prohibition.themobmuseum.org/the-history/the-road-to-prohibition/the-temperance-movement">often led by women</a> – looked at poverty, domestic violence, labor unrest and other social problems and connected them with drinking alcohol. </p>
<p>So-called “temperance” activists worked for years to limit alcohol consumption in the U.S. by promoting moderation and voluntary abstinence. “Prohibitionists,” by contrast, pushed to restrict the times and places liquor could be sold. Interrupted only briefly by the Civil War, both groups used moral suasion and political lobbying to <a href="https://www.ncbi.nlm.nih.gov/books/NBK216414/">shift the culture and the laws around alcohol</a>.</p>
<p>Their tactics worked. Fraternal organizations promoted abstinence as a sound business principle; saloons were closed by prayer vigils; and many states enacted local provisions that allowed counties and municipalities to vote in bans or restrictions on liquor sales. </p>
<p>But by the early 20th century, “the liquor traffic” – the network of manufacturers and distributors, and the politicians who benefited from their kickbacks – seemed unstoppable. Around the nation, even in “dry” counties, “<a href="https://www.gotrum.com/the-rum-university/rum-in-history/american-Rum-27-Demon-Rum/">demon rum</a>” flowed freely. </p>
<p>When men – problem drinkers were then, as now, <a href="https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm">disproportionately male</a> – fell victim to its seductions, they abandoned their roles at home and in the workplace. This bad behavior threatened the social order.</p>
<p>In 1913, the <a href="http://www.westervillelibrary.org/AntiSaloon">Anti-Saloon League</a>, which had previously championed the local option as a way to gradually reform the nation, had had enough. It was clear they could not shame or regulate the liquor traffic into limiting its hold on men’s lives. That left only one alternative, which had first been proposed two decades before by Archbishop John Ireland of St. Paul, Minnesota: “<a href="https://www.newspapers.com/clip/4540146/evening-gazette/">there is nothing now to be done but to wipe it out completely</a>.”</p>
<p>It took just six years for Congress to pass the 18th Amendment and for the states to ratify it, banning the production, transport and sale of intoxicating liquors. In January 1920, America was officially cleansed of “<a href="https://www.davidanthembookseller.com/pages/books/00926/hon-richmond-p-hobson/the-great-destroyer-alcohol-devours-the-products-of-civilization">the great destroyer</a>.” </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Men pour bottles into a storm drain" src="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393265/original/file-20210402-15-1i7gxkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During Prohibition, alcohol was illegal but common, and when it was found by authorities, it was destroyed.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2001706109/">Library of Congress</a></span>
</figcaption>
</figure>
<h2>A new understanding?</h2>
<p>Even most Prohibition advocates quickly realized that alcohol could not really be wiped out of American life. </p>
<p>The nation also learned that the cost of trying was itself sky high. Illegal and bootleg spirits were more expensive – and often toxic. Instead of turning men into hardworking teetotalers, <a href="https://www.history.com/news/prohibition-organized-crime-al-capone">Prohibition encouraged new kinds of social deviance</a>, such as organized crime.</p>
<p>When Prohibition was repealed in 1933, the liquor industry and its political patrons established and funded what historians call the “<a href="https://academic.oup.com/alcalc/article/35/1/10/142396#1129078">modern alcoholism movement</a>.” This was a group of activist scientists, public relations experts and reformed drinkers looking to promote a <a href="http://www.roizen.com/ron/postrepeal.htm">responsible solutions to the problems of alcohol</a> – while also keeping the booze flowing. </p>
<p>This movement acknowledged that some people were problem drinkers, but argued that neither the industry nor alcohol itself was to blame. Instead, during the 1940s and 1950s, movement members recast drunkenness as a personal and, significantly, a medical issue. They called it “<a href="https://doi.org/10.1111/add.14400">the disease of alcoholism</a>.”</p>
<p>This new disease was <a href="https://silkworth.net/alcoholics-anonymous/alcoholism-as-a-manifestation-of-allergy/">like an allergy</a>. It was mysterious; it was not clear why some people developed a compulsion to drink. More important, it was rare: Most people could drink socially without ill effect. Those who could not deserved help, not scorn. </p>
<p>This medicalized approach claimed that with understanding and fellowship – such as that provided by Alcoholics Anonymous – disease sufferers could remain cheerfully abstinent. The scientific community would work to <a href="https://www.theatlantic.com/health/archive/2012/02/mrs-marty-mann-and-the-early-medicalization-of-alcoholism/252286/">unlock the secrets of the disease of alcoholism</a>, just as it had with tuberculosis and polio. In the meantime, the undiseased could enjoy the three-martini lunches and suburban cocktail parties that symbolized the postwar American good life.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sits with a drink glass in one hand and the other hand over his face" src="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393294/original/file-20210402-23-m9gv6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not everyone was able to drink without problems.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/alcohol-addiction-royalty-free-image/962083312">D-Keine/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Diseases spread</h2>
<p>Billions of research dollars later, there is <a href="https://dx.doi.org/10.1111%2Facer.14246">no clear consensus</a> that the compulsive use of alcohol – or any other drug – is the effect or the cause of any <a href="https://doi.org/10.1901/jeab.2011.95-263">physiological or genetic abnormality, or whether it is just bad decision-making</a>.</p>
<p>But reframing problem drinking as a disease had helped everyone move on from the disastrous experiment of Prohibition. Alcoholics got sympathy, research scientists won government grants and the liquor industry made plenty of money marketing alcohol to Americans without the disease.</p>
<p>The disease concept was so useful to so many people that in the late 20th century, it migrated out of the alcohol and drug world. Overindulgence in anything – including work, exercise and sex – became known as “<a href="https://dx.doi.org/10.3109%2F00952990.2010.491884">behavioral addiction</a>.” </p>
<p>Near-total lack of evidence that <a href="https://doi.org/10.1016/j.euroneuro.2015.08.013">such compulsive behavior has physiological roots</a> has not stopped Americans from seeing it as disease. </p>
<p>The alleged Atlanta shooter fell into this trap. He was a man whose appetite for sex was <a href="https://www.nytimes.com/2021/03/18/us/robert-aaron-long-atlanta-spa-shooting.html">larger than he thought it should be</a>. His Christian community called that a sin. When he couldn’t pray his desires away, he appears to have borrowed a concept from the secular world and <a href="https://theconversation.com/sex-addiction-isnt-a-justification-for-killing-or-really-an-addiction-it-reflects-a-persons-own-moral-misgivings-about-sex-157543">decided to treat it as a disease</a>. </p>
<p>When that modern approach didn’t work, he took a step back in time, reverting to the old Prohibitionist tactic of eliminating what he believed to be the source of his problems. </p>
<p>The Anti-Saloon League used pressure tactics to change legislation. Robert Aaron Long got a gun and ended women’s lives.</p>
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<p class="fine-print"><em><span>Trysh Travis has received funding from the National Endowment for the Humanities for research on the history of Alcoholics Anonymous and its offshoots.</span></em></p>The story of the alleged Atlanta shooter highlights the two most common ways Americans think about compulsive behaviors – considering them the results of temptation and treating them as diseases.Trysh Travis, Associate Professor of Women's Studies, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1061292018-12-11T14:22:51Z2018-12-11T14:22:51ZThe problem of drinking in pregnancy – and what to do about it<figure><img src="https://images.theconversation.com/files/249941/original/file-20181211-76980-tvb0hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The UK is believed to have one of the highest rates of Foetal Alcohol Syndrome in the world.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Last year, <a href="https://www.telegraph.co.uk/science/2017/01/19/four-10-british-mothers-drink-pregnancy-one-worst-rates-europe/">it was reported that the UK</a> has one of the worst rates of drinking while pregnant in Europe. These figures come from <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30021-9/fulltext">a study</a> which shows 41% of women in the UK drank alcohol during their pregnancy. Among UK women who drink any alcohol when pregnant, an estimated 19% drink <a href="https://www.sciencedirect.com/science/article/pii/S0890623817302824?via%3Dihub#sec0100">more than seven units of alcohol on one occasion</a>. This is defined as binge drinking.</p>
<p>Research has also found that the UK has one of the highest predicted prevalence of Foetal Alcohol Syndrome in the world. Foetal Alcohol Syndrome is the most severe form of <a href="http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=18719155">Foetal Alcohol Spectrum Disorders</a>, a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. </p>
<p>Foetal Alcohol Spectrum Disorders include a range of physical, mental, behavioural and learning disabilities. In the UK, 61 cases are estimated to occur for every 10,000 births. This is significantly higher that the global average of 15 out of 10,000 births. </p>
<p>These numbers however, do not give a picture of either timing or levels of alcohol exposure. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/acer.13305">Australian research</a>, for example, shows that many women drink in the period before they know they are pregnant, but far fewer women continue when they find out they are pregnant. Similarly, <a href="https://beta.gov.scot/publications/scottish-maternal-infant-nutrition-survey-2017/pages/4/">a Scottish survey</a> reported that 12% of women drank after pregnancy confirmation – compared to 66% who drank before. </p>
<p>But of course, a limitation of these studies, as with any research study, is that they are restricted to individuals and may not be representative of the whole population.</p>
<h2>Mixed messages</h2>
<p>The fact then that a <a href="https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-4-health-of-children-in-the-early-years">recent report</a> by Public Health England on child health outcomes did not include alcohol as a contributing factor, seems very shortsighted. This is despite acknowledging that lifestyle factors are key determinants for child health in early years. </p>
<p>In the UK, there is no consistent system in place to monitor prevalence of alcohol use among pregnant women. Midwives ask about alcohol during the booking appointment, but it is not mandatory to record the information in a woman’s notes. Without confirmation of alcohol use during pregnancy, diagnosing Fetal Alcohol Spectrum Disorders and putting appropriate support in place, becomes much more difficult. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249011/original/file-20181205-186085-1pv4p1h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many women continue to drink while trying to conceive.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The advice given to pregnant women in the UK about drinking alcohol during pregnancy has changed over time. In 2016, the Chief Medical Officers in the UK updated their <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf">guidelines</a> to recommend pregnant women abstain from alcohol. Previously the National Institute for Health and Care Excellence recommended women avoid alcohol, but limit their intake if they chose to drink. The reason for the change in recommendation was the uncertainty of whether drinking small amounts of alcohol is harmful. These guidelines align with many other countries, who also adopt the “precautionary principle”. </p>
<p>A study comparing experiences in England and Sweden showed both <a href="https://doi.org/10.1080/09687637.2018.1478949">midwives</a> and <a href="https://doi.org/10.1093/eurpub/ckx208">new parents</a> in England thought small amounts of alcohol might not harm the baby. In Sweden – where only one in ten women drink any alcohol during pregnancy – any alcohol was seen as risky, indicating that abstinence was generally accepted. </p>
<h2>Learning from others</h2>
<p>A new Fetal Alcohol Spectrum Disorders strategy has been published <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/55E4796388E9EDE5CA25808F00035035/$File/National%20Fetal%20Alcohol%20Spectrum%20Disorder%20Strategic%20Action%20Plan%202018-2028.pdf">in Australia</a> and
in Canada, a <a href="http://www.phac-aspc.gc.ca/hp-ps/dca-dea/prog-ini/fasd-etcaf/publications/cp-pc/pdf/cp-pc-eng.pdf">four-step prevention model</a> has been adopted by public health and research institutions. The Canadian model focuses on women making informed decisions and pregnancy planning to reduce the risk of harm. </p>
<p>Although not perfect, the model <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861006/">has influenced prevention efforts</a> across all levels – from preconception to supporting new mothers. There is good evidence that information on alcohol and contraception to women of reproductive age can help to <a href="http://www.euro.who.int/en/publications/abstracts/prevention-of-harm-caused-by-alcohol-exposure-in-pregnancy.-rapid-review-and-case-studies-from-member-states-2016">prevent an alcohol-exposed pregnancy</a>. </p>
<p>Australia and New Zealand recently voted in favour of mandatory <a href="https://www.theguardian.com/australia-news/2018/oct/12/alcohol-labels-warning-of-risk-from-drinking-while-pregnant-will-save-lives">pregnancy warning on alcohol containers</a>. In Europe, it is compulsory for alcohol containers to carry warning labels in a handful of countries. There is no UK legislation on labelling, research shows that <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13094">95% of products carry a warning</a> – most commonly a logo without text. Of course, warning labels aren’t a solution in themselves. Research shows that they can [stimulate conversations about alcohol] but we know less about how they <a href="http://www.ijadr.org/index.php/ijadr/article/view/126">affect behaviour</a>.</p>
<h2>Supportive alcohol policy</h2>
<p>Across the UK, there are positive developments in general alcohol policy – actions that will also have an impact of alcohol use during pregnancy. </p>
<p>This includes the introduction of a minimum unit pricing on alcohol in Scotland and the updated <a href="https://www.gov.scot/publications/alcohol-framework-2108-preventing-harm-next-steps-changing-relationship-alcohol/">Scottish Alcohol Framework </a>. The <a href="https://hansard.parliament.uk/Commons/2018-05-08/debates/54040204-9E54-4E2D-B9B0-21A9D4A24A2D/AlcoholMinimumUnitPricing#contribution-BA49A8DF-8F73-41AE-99E3-D5B4956E4297">UK government has also started the process</a> on a new alcohol strategy, but more still needs to be done.</p>
<p>Consistent, comparable data collection and prioritising women who consume alcohol during pregnancy is a first step forward for prevention, as is a coordinated approach for future alcohol policy. This will ensure the UK will not lag behind in addressing this important public health issue and that women, partners and children receive timely and appropriate support, where needed.</p><img src="https://counter.theconversation.com/content/106129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Scholin receives funding from the Institute for Alcohol Studies. </span></em></p><p class="fine-print"><em><span>Carolyn Blackburn is affiliated with the FASD UK Alliance who campaign for awareness about FASD and support for families.</span></em></p><p class="fine-print"><em><span>Lesley Smith receives funding from the Institute for Alcohol Studies.</span></em></p><p class="fine-print"><em><span>Moira Plant has in the past received funding from government and other bodies including the alcohol industry, the WHO and the Welcome Trust . </span></em></p><p class="fine-print"><em><span>Julie Watson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The UK is lagging behind the rest of the world when it comes to preventing harm caused by drinking during pregnancy.Lisa Schölin, Public health Research Fellow, The University of EdinburghCarolyn Blackburn, Reader in Interdisciplinary Practice and Research with Famililies, Birmingham City UniversityJulie Watson, Lecturer/Researcher, School of Health & Social Work, Faculty Health Science, University of HullLesley Smith, Professor of Women's Public Health, Institute of Clinical and Applied Health Research, University of HullMoira Plant, Emertus Professor of Alcohol Studies, University of the West of EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/652012016-10-25T02:34:17Z2016-10-25T02:34:17ZAlcoholism research: A virus could manipulate neurons to reduce the desire to drink<figure><img src="https://images.theconversation.com/files/142937/original/image-20161024-28409-qxlg3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Heavy drinking can cause brain changes that make you want to drink more. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-243381178.html">Alcohol shots image via www.shutterstock.com.</a></span></figcaption></figure><p>About <a href="http://www.rsoa.org/RSA-2014WhitePaperFinalVersionVH.pdf">17 million adults</a> and more than <a href="https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders">850,000 adolescents</a> had some problems with alcohol in the United States in 2012. Long-term alcohol misuse could harm your liver, stomach, cardiovascular system and bones, as well as your brain. </p>
<p>Chronic heavy alcohol drinking can lead to a problem that we scientists call <a href="https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders">alcohol use disorder</a>, which most people call alcohol abuse or alcoholism. Whatever name you use, it is a severe issue that affects millions of people and their families and causes <a href="http://www.cdc.gov/features/alcoholconsumption/">economic burdens</a> to our society. </p>
<p>Quitting alcohol, like quitting any drug, is hard to do. One reason may be that heavy drinking can actually change the brain.</p>
<p>Our <a href="https://medicine.tamhsc.edu/next/faculty/jun-wang.html">research team</a> at <a href="http://people.tamu.edu/%7Ejwang188/">Texas A&M University Health Science Center</a> has found that alcohol changes the way information is processed through specific types of neurons in the brain, encouraging the brain to crave more alcohol. Over time, the more you drink, the more striking the change. </p>
<p>In <a href="http://dx.doi.org/10.1016/j.biopsych.2016.05.016">recent research</a> we identified a way to mitigate these changes and reduce the desire to drink using a genetically engineered virus. </p>
<h2>Alcohol changes your brain</h2>
<p>Alcohol use disorders <a href="http://www.dsm5.org/Pages/Default.aspx">include alcohol abuse and alcohol dependence</a>, and can be thought of as an addiction. Addiction is a chronic brain disease. It causes abnormalities in the connections between neurons. </p>
<p>Heavy alcohol use can cause changes in a region of the brain, <a href="http://dx.doi.org/10.1016/j.neuron.2013.05.014">called the striatum</a>. This part of the brain processes all sensory information (what we see and what we hear, for instance), and sends out orders to control motivational or motor behavior. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=341&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=341&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=341&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=429&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=429&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142411/original/image-20161019-20298-frzos5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=429&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The striatum is a target for drugs.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AStriatum.png">Life Science Databases via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The striatum, which is located in the forebrain, is a <a href="http://dx.doi.org/10.1523/JNEUROSCI.2783-12.2012">major target</a> for <a href="http://dx.doi.org/10.1016/j.cell.2015.07.046">addictive drugs</a> and <a href="http://dx.doi.org/10.1523/JNEUROSCI.0003-15.2015">alcohol</a>. Drug and alcohol intake can profoundly increase the level of dopamine, a neurotransmitter associated with pleasure and motivation, in the striatum.</p>
<p>The neurons in the striatum have higher densities of dopamine receptors as compared to neurons in other parts of the brain. As a result, striatal neurons are more susceptible to changes in dopamine levels. </p>
<p>There are two main types of neurons in the striatum: D1 and D2. While both receive sensory information from other parts of the brain, they have nearly opposite functions. </p>
<p>D1-neurons control “go” actions, which encourage behavior. D2-neurons, on the other hand, control “no-go” actions, which <a href="http://dx.doi.org/10.1016/j.neuron.2015.08.039">inhibit behavior</a>. Think of D1-neurons like a green traffic light and D2-neurons like a red traffic light. </p>
<p>Dopamine affects these neurons in different ways. It promotes D1-neuron activity, turning the green light on, and suppresses D2-neuron function, turning the red light off. As a result, dopamine promotes “go” and inhibits “no-go” actions on reward behavior. </p>
<p>Alcohol, especially excessive amounts, can hijack this reward system because it increases dopamine levels in the striatum. As a result, your green traffic light is constantly switched on, and the <a href="http://dx.doi.org/10.1016/j.biopsych.2016.05.016">red traffic light doesn’t light up</a> to tell you to stop. This is why heavy alcohol use pushes you to drink to excess more and more. </p>
<p>These brain changes last a very long time. But can they be mitigated? That’s what we want to find out.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=459&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=459&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=459&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=577&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=577&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137961/original/image-20160915-30575-4d59k2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=577&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What’s in that bottle?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-390336520/stock-photo-curious-white-rat-in-a-cage-shallow-dof-selective-focus-on-the-rat-paw-and-eyes.html?src=YmsaSKVEerggrZAVc09dyQ-4-60">Lab rat via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>Can we mitigate these changes?</h2>
<p>We started by presenting mice with two bottles, one containing water and the other containing 20 percent alcohol by volume, mixed with drinking water. The bottle containing alcohol was available every other day, and the mice could freely decide which to drink from. Gradually, most of animals developed a drinking habit. </p>
<p>We then used a process called <a href="http://neuroscience.mssm.edu/nestler/viralmediated.html">viral mediated gene transfer</a> to manipulate the “go” or “no-go” neurons in mice that had developed a drinking habit.</p>
<p>Mice were infected with a genetically engineered virus that delivers a gene into the “go” or “no-go” neurons. That gene then drives the neurons to express a specific protein. </p>
<p>After the protein is expressed, we injected the mice with a chemical that recognizes and binds to it. This binding can inhibit or promote activity in these neurons, letting us turn the green light off (by inhibiting “go” neurons) or turn the red light (by exciting “no-go” neurons) back on.</p>
<p>Then we measured how much alcohol the mice were consuming after being “infected,” and compared it with what they were drinking before.</p>
<p>We found that either inhibiting the “go” neurons or turning on the “no-go” neurons successfully reduced alcohol drinking levels and preference for alcohol in the “alcoholic” mice. </p>
<p>In another experiment in this study, we found that directly delivering a drug that excites the “no-go” neuron into the striatum can also reduce alcohol consumption. Conversely, in a previous experiment we found that directly delivering <a href="http://dx.doi.org/10.1523/JNEUROSCI.0003-15.2015">a drug that inhibits the “go” neuron</a> has the same effect. Both results may help the development of clinical treatment for alcoholism.</p>
<h2>What does this mean for treatment?</h2>
<p>Most people with an alcohol use disorder can benefit from <a href="http://pubs.niaaa.nih.gov/publications/Treatment/treatment.htm">treatment</a>, which can include a combination of medication, counseling and support groups. Although medications, such as Naltrexone, to help people stop drinking can be effective, none of them can accurately target the specific neurons or circuits that are responsible for alcohol consumption. </p>
<p>Employing viruses to deliver specific genes into neurons has been for disorders such as <a href="http://pdcenter.neurology.ucsf.edu/professionals-guide/gene-therapy-pd">Parkinson’s disease</a> in humans. But while we’ve demonstrated that this process can reduce the desire to drink in mice, we’re not yet at the point of using the same method in humans. </p>
<p>Our finding provides insight for clinical treatment in humans in the future, but using a virus to treat alcoholism in humans is probably still a long way off.</p><img src="https://counter.theconversation.com/content/65201/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yifeng Cheng receives funding from Texas Research Society on Alcoholism. </span></em></p><p class="fine-print"><em><span>Jun Wang receives funding from NIAAA/NIH. </span></em></p>Heavy drinking causes brain changes that make you want to drink more. But using a virus to deliver a gene into specific neurons in the brain may be a way to mitigate those changes.Yifeng Cheng, Ph.D. Candidate, Texas A&M University Health Science Center, Texas A&M UniversityJun Wang, Assistant Professor of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center , Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/436782015-06-24T13:52:51Z2015-06-24T13:52:51ZWhat happens to those left behind by a drug or alcohol-related death?<figure><img src="https://images.theconversation.com/files/86247/original/image-20150624-31526-6yeysj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Left alone</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The people left behind when someone close to them dies from drug or alcohol use are often forgotten about, especially when it comes to research. Yet the numbers of those affected by these deaths are far from insignificant.</p>
<p>There were well over <a href="http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Alcohol-related+Deaths">8,000 alcohol-related</a> and <a href="http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Drug-related+Deaths">4,000 drug-related deaths</a> registered in England and Wales in 2012. And the actual numbers are likely to be far higher than suggested by official statistics because some deaths are not recorded or categorised as being alcohol or drug-related.</p>
<p>Such deaths are frequently featured in the press, especially those of young people and celebrities. But they are often reported in a way that distances the reader rather than inviting sympathy for grieving family members. One bereaved father interviewed for our research on this topic, reflecting on news coverage of his son’s death, said:</p>
<blockquote>
<p>I just read ‘Unemployed man dies of drug overdose’ and read down through and it was [my son] and I don’t think the main point about him was that he was unemployed. There was more to [him] than an unemployed man.</p>
</blockquote>
<p>Indeed, those left behind are more likely to be pathologised and stigmatised as part of the problem. One bereaved mother who tried to get help with her son’s problem drinking said: </p>
<blockquote>
<p>It would seem that they immediately went down the route of what’s going on in the family? …this is a family that aren’t functioning well together.</p>
</blockquote>
<p>As such, the bereaved families of drug or alcohol-related deaths remain a hidden and neglected group, with profound consequences for their own health and well-being.</p>
<h2>Poor treatment</h2>
<p>One consequence of this stigma is the frequently poor and insensitive treatment these bereaved people may receive at the hands of the professionals dealing with this kind of death. This can include those working for the NHS, police and legal authorities, funeral services and drug and alcohol treatment and bereavement services.</p>
<p>This was the situation we found during <a href="http://www.bath.ac.uk/cdas/research/understanding-those-bereaved-through-substance-misuse/">a study</a> by the universities of Bath and Stirling involving lengthy interviews with 106 family members bereaved in this way. Finding such a relatively large sample is perhaps evidence of just how much it has meant to this group of bereaved people to have the chance to tell their stories. Some participants reported being treated with empathy and respect. But more often they met with responses that reinforced the sense that their loss was considered less important than that associated with other types of death. </p>
<p>One bereaved mother talking about the death of her son reported people’s negative reaction thus:</p>
<blockquote>
<p>'He was on drugs, what do you expect?’ That was the impression you got. That was the truth of what they were thinking. Whether they were saying ‘so and so’ to me, they are saying to themselves: ‘Another one bites the dust.’ </p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/86248/original/image-20150624-31498-k7wkoh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dealing with grief.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Such treatment is all the more distressing for the bereaved person when they have to negotiate an unfamiliar, complex, confusing and time-consuming process involving a range of separate organisations, often with little or no guidance. Indeed, as we discovered in focus groups with 40 practitioners representing the range of services involved, there is little in the way of any coherent national or local strategy in how organisations respond.</p>
<p>Instead we found that practitioners are also up against the system. Poor responses in part reflect the disparate working practices and cultures between organisations, in which practitioners inevitably lose sight of the bigger picture. The main concern of the front-line services involved in the most immediate aftermath of the death, such as the police, is with the deceased and establishing the cause of death, rather than with the grief of those left behind.</p>
<p>However, we have also been fortunate enough to be able to work with these practitioners to make real inroads into improving the way those bereaved through substance use are treated. A working group of 12 mainly front-line practitioners took on the task of developing a set of best-practice guidelines for those whose work brings them into contact with these bereaved people.</p>
<h1>New guidelines</h1>
<p>Written by practitioners for practitioners, these guidelines directly engage the reader and invite empathy for the bereaved by explaining their predicament. They are built around <a href="http://www.bath.ac.uk/research/news/2015/06/23/bereavement-guidelines/">five key messages</a> from the interview data, which reflected what the bereaved family members said they needed. These messages are that every practitioner must remember: to show kindness and compassion; that language is important; that every bereaved person is an individual; that everyone can make a contribution; and to work together.</p>
<p>In practice, we hope these principles will encourage practitioners to take actions that will improve the way they work with the bereaved. This can range from simple things like referring to their “son” or “wife” rather than “the deceased”, to carrying out careful planning with the bereaved person of the time they will work with them. We have also provided guidance for practitioners on dealing with specific situations, such as acknowledging a bereaved person’s anger or criticisms towards an organisation and seeking support if the practitioners themselves feel guilty.</p>
<p>By encouraging practitioners to prioritise the human element of their work, the guidelines will promote a culture shift in the way these bereaved people are treated. This can counter rather than reinforce social stigma, reducing their stress and supporting their well being.</p><img src="https://counter.theconversation.com/content/43678/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Valentine receives funding from ESRC.</span></em></p>New research aims to bring hope to the often forgotten or stigmatised friends and relatives of those who die from drug or alcohol use.Christine Valentine, Research associate in sociology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/378552015-02-23T23:24:38Z2015-02-23T23:24:38ZCould research into oxytocin and alcohol lead to a ‘sobriety pill’?<figure><img src="https://images.theconversation.com/files/72750/original/image-20150223-32238-16l3q9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What if we had a pill that nullified some of the negative effects of alcohol and helped alcoholics drink less?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/carbonnyc/8686574743/in/photolist-eeAY34-pcLepZ-d135Eu-gubuQ1-tgLsw-6KpmFc-69mdTa-9KZDdk-c6WdSQ-dC9bQW-7jpVsh-4AfhTX-4Afik4-92Efy7-ja5j7-fyHGiw-61kmiC-8pYi9q-4A8gGt-dxomPh-6DtJ5V-7WtLCE-ehvzvH-51AfA3-7rDbu6-5rkGVB-pS94c-89g2X7-6PAEaw-drzG99-AV33q-ftPrit-o3YBAx-8HrnEu-fqKzC-5qDmtn-5b747n-bB3QUc-2o5ue-kTZe2y-2k8aah-9U7zdS-xZba-8Lwa8n-kWyqX-9YCLMM-dACPRL-apo9St-5eWDMm-8tTuUZ">David Goehring/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Each year over <a href="http://www.who.int/mediacentre/news/releases/2014/alcohol-related-deaths-prevention/en/">three million people</a> die due to alcohol-related causes. To put that in perspective, that’s a whopping 5.9% of all deaths worldwide. Meanwhile, countless others endure the adverse health effects of <a href="https://theconversation.com/au/topics/alcohol">alcohol use</a>. Unfortunately, current psychological and pharmacological treatments for alcohol-use disorders are only marginally better than placebo in reducing intake.</p>
<p>Imagine, then, if problem drinkers could be given a pill that makes them less likely to drink, less intoxicated if they do drink and more capable of enduring the potentially life-threatening alcohol withdrawal syndrome that emerges shortly after going “cold-turkey”. </p>
<p>Recent research exploring interactions between the neuropeptide <a href="https://theconversation.com/au/topics/oxytocin">oxytocin</a> and alcohol gives some grounds for hope that such a pill might one day exist. </p>
<p>Oxytocin is sometimes referred to as the “<a href="http://www.dailymail.co.uk/sciencetech/article-2786760/The-love-hormone-revealed-Scientists-unravel-sexual-sparked-females.html">love hormone</a>” or “cuddle hormone”. It has a high profile in popular culture due to its role in promoting sociability and long-term bonding. Numerous human studies, often involving nasal puffs of oxytocin, show various <a href="http://www.webmd.com/sex-relationships/news/20131125/how-the-love-hormone-works-its-magic">prosocial effects</a>. </p>
<p>Oxytocin is also known to interact with alcohol. In the 1980s it was discovered that oxytocin can prevent the development of tolerance to alcohol’s sedative and body temperature reducing effects in rodents, and reduce the severity of alcohol withdrawal.</p>
<p>More recently, we reported that oxytocin causes both immediate and long-lasting inhibition of <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027237">alcohol consumption in rodents</a>. Furthermore, repeated exposure to oxytocin promotes <a href="http://www.sciencedirect.com/science/article/pii/S0018506X11002765">addiction-resistant behaviour</a> characterised by reduced anxiety, higher sociability and greater activity of the natural oxytocin system.</p>
<h2>Oxytocin blocks alcohol intoxication</h2>
<p>In research published this week in the <a href="http://www.pnas.org/cgi/doi/10.1073/pnas.1416900112">Proceedings of the National Academy of Sciences</a> we provide perhaps one of the most striking demonstrations to-date of oxytocin’s interaction with alcohol.</p>
<p>We infused oxytocin into the brains of rats that were then given an intoxicating dose of alcohol. The oxytocin completely prevented the discoordination caused by the alcohol in the rat equivalent of a field sobriety test. You can see the results in the video below:</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/xkQSlVQMi0M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The rat given oxytocin behaves just like the sober rat, even though it has been given a high dose of alcohol.</span></figcaption>
</figure>
<p>We then went on to demonstrate that oxytocin prevents alcohol from acting at specific sites in the brain involved in alcohol intoxication, sites known as delta subunit-containing GABA-A receptors. This was a particularly striking discovery in that oxytocin is normally thought to bind primarily to its own oxytocin receptors and a population of receptors for the closely related peptide vasopressin.</p>
<p>Other recent research suggests that delta subunit GABA-A receptors also play a role in alcohol addiction and tolerance. Changing the density of these receptors using a specially engineered virus can lead to a reduced appetite for alcohol.</p>
<p>Our demonstration that oxytocin prevents alcohol acting at these receptors therefore suggests a hitherto unknown mechanism involved in the wide-ranging interactions between alcohol and oxytocin as reported in other studies. </p>
<h2>Developing a ‘sobriety’ pill</h2>
<p>So in rodents, at least, oxytocin reduces alcohol consumption in both the short- and long-term. It also prevents alcohol-induced intoxication, reduces the severity of alcohol withdrawal and promotes behaviour resistant to addiction and relapse. </p>
<p>These wide ranging effects of oxytocin on addiction-relevant behaviours sound much like the “sobriety” pill imagined at the beginning of this article. The challenge now is to translate these findings into humans.</p>
<p>One major hurdle will be to make sure that we can deliver the large oxytocin molecule in a way that allows it to effectively enter the brain. In rodent studies we do this by administering oxytocin directly into the brain or by giving very high doses peripherally.</p>
<p>In human studies, oxytocin is usually given via a nasal spray, with the theory being that this provides a “back-door” into the brain. But there is debate as to how effective this actually is in raising brain oxytocin levels. </p>
<p>To-date only one small pilot trial of oxytocin in the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2012.01958.x/abstract">clinical treatment of alcoholism</a> has been published. Alcoholics undergoing inpatient detoxification who were treated with intranasal oxytocin had reduced alcohol cravings and required less standard pharmacological treatment to treat their withdrawal symptoms. This study requires extension and replication but is an encouraging start.</p>
<p>But we’re yet to demonstrate the “sobering-up” effect of oxytocin in humans, although we’re planning to test that in future studies. Assuming enough of the oxytocin reaches the brain, we suspect that oxytocin might reduce motor discoordination after consuming alcohol and also rescue slurred speech and impaired cognition. We’re also interested in the pacifying and anti-aggressive effects of oxytocin. </p>
<p>Each year in Australia there are around <a href="http://www.abc.net.au/news/2014-07-31/15-australians-die-each-day-from-alcohol-related-illness-study/5637050">65,000 hospitalisations and 1,500 deaths</a> due to alcohol-related injuries. If oxytocin is able to inhibit intoxication in these people it could greatly reduce their risk of such injury. But even better, it might prevent excessive alcohol consumption in the first place.</p>
<p>It’s still early days, but the more we learn about <em>how</em> oxytocin causes such a wide range of positive effects on alcohol-induced behaviours, the closer we may get to a “sobriety” pill being science fact rather than science fiction.</p><img src="https://counter.theconversation.com/content/37855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael T. Bowen currently receives funding from The National Health and Medical Research Council for oxytocin-related research. He is an inventor on a patent relating to oxytocin's inhibitory effects on alcohol consumption (<a href="http://www.google.com/patents/US20120270785">http://www.google.com/patents/US20120270785</a>).</span></em></p><p class="fine-print"><em><span>Iain S. McGregor currently receives and has previously received funding from The National Health and Medical Research Council for oxytocin-related research. He is an inventor on a patent relating to oxytocin's inhibitory effects of alcohol consumption (<a href="http://www.google.com/patents/US20120270785">http://www.google.com/patents/US20120270785</a>). </span></em></p>Imagine a pill that nullified some of the nasty effects of alcohol. A new study looking at oxytocin suggests such a pill might be possible.Michael T. Bowen, NHMRC Peter Doherty Biomedical Fellow, University of SydneyIain S McGregor, Professor of Psychopharmacology at the School of Psychology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.