tag:theconversation.com,2011:/uk/topics/alcohol-abuse-6457/articlesAlcohol abuse – The Conversation2024-01-22T13:32:06Ztag:theconversation.com,2011:article/2201342024-01-22T13:32:06Z2024-01-22T13:32:06ZAlcohol and drugs rewire your brain by changing how your genes work – research is investigating how to counteract addiction’s effects<figure><img src="https://images.theconversation.com/files/569941/original/file-20240117-21-ycbpim.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3600%2C1810&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol and other drugs can overpower the reward pathways of the brain.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/illustration-of-a-brain-cocktail-isolate-don-a-royalty-free-image/1263367270">Simona Dumitru/Moment via Getty Images</a></span></figcaption></figure><p>Many people are wired to <a href="https://www.penguinrandomhouse.ca/books/306396/the-compass-of-pleasure-by-david-j-linden/9780143120759">seek and respond to rewards</a>. Your brain interprets food as rewarding when you are hungry and water as rewarding when you are thirsty. But addictive substances like alcohol and drugs of abuse can <a href="https://doi.org/10.1016/S2215-0366(16)00104-8">overwhelm the natural reward pathways</a> in your brain, resulting in intolerable cravings and reduced impulse control. </p>
<p>A popular misconception is that addiction is a result of low willpower. But an explosion of knowledge and technology in the field of <a href="https://plato.stanford.edu/entries/molecular-genetics/">molecular genetics</a> has changed our basic understanding of addiction drastically over the past decade. The general consensus among scientists and health care professionals is that there is a <a href="https://www.penguinrandomhouse.ca/books/557515/never-enough-by-judith-grisel/9780525434900">strong neurobiological and genetic basis</a> for addiction.</p>
<p>As a <a href="https://scholar.google.com/citations?user=XgunjGkAAAAJ&hl=en">behavioral neurogeneticist</a> <a href="https://www.kaunlab.com">leading a team</a> investigating the molecular mechanisms of addiction, I combine neuroscience with genetics to understand how alcohol and drugs influence the brain. In the past decade, I have seen changes in our understanding of the molecular mechanisms of addiction, largely due to a better understanding of how genes are dynamically regulated in the brain. New ways of thinking about how addictions form have the potential to change how we approach treatment.</p>
<h2>Alcohol and drugs affect brain gene activity</h2>
<p>Each of your brain cells has your genetic code stored in long strands of DNA. For all that DNA to fit into a cell, it needs to be packed tightly. This is achieved by winding the DNA around “spools” of protein <a href="https://www.genome.gov/genetics-glossary/histone">called histones</a>. Areas where DNA is unwound contain active genes coding for proteins that serve important functions within the cell.</p>
<p>When gene activity changes, the proteins your cells produce also change. Such changes can range from a single neuronal connection in your brain to how you behave. This genetic choreography suggests that while your genes affect how your brain develops, <a href="https://theconversation.com/brains-work-via-their-genes-just-as-much-as-their-neurons-47522">which genes are turned on or off</a> when you are learning new things is dynamic and adapts to suit your daily needs.</p>
<p>Recent data from animal models suggests that alcohol and drugs of abuse directly influence <a href="https://doi.org/10.1523/JNEUROSCI.1649-20.2020">changes in gene expression</a> in areas of the brain that help drive memory and reward responses. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram magnifying the nucleus of a neuron, showing spirals of DNA wound around bundles of protein" src="https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=358&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=358&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=358&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Within each neuron in the brain, how tightly DNA is wound around or bound to histones and other proteins determines which genes are expressed and which proteins are produced.</span>
<span class="attribution"><span class="source">Karla Kaun and Vinald Francis</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>There are <a href="https://doi.org/10.1523/JNEUROSCI.1649-20.2020">many ways</a> addictive substances can change gene expression. They can alter which proteins bind to DNA to turn genes on and off and which segments of DNA are unwound. They can change the process of how DNA is read and translated into proteins, as well as alter the proteins that determine how cells use energy to function.</p>
<p>For example, alcohol can cause an alternative form of a gene to be expressed in the memory circuits <a href="https://doi.org/10.1534/genetics.120.303101">in flies</a> <a href="https://doi.org/10.1038/s41598-023-30926-z">and people</a>, resulting in changes in dopamine receptors and transcription factors involved in reward signaling and neuronal function. Similarly, cocaine can cause an alternative form of a gene to be expressed in the <a href="https://doi.org/10.1016/j.neuron.2021.08.008">reward centers</a> <a href="https://doi.org/10.1016/j.biopsych.2017.11.027">of mice</a>, leading them to seek out more cocaine.</p>
<p>Exactly how these drugs cause changes in gene regulation is unknown. However, a direct link between alcohol consumption and changes in gene expression in mice provides a clue. A byproduct of alcohol being broken down in the liver called acetate can cross the blood-brain barrier and <a href="https://doi.org/10.1038/s41586-019-1700-7">unwind DNA from histones</a> in mouse memory circuits. </p>
<p>Alcohol, nicotine, cocaine and opioids also all activate important signaling pathways that are <a href="https://doi.org/10.1111/jnc.12725">central regulators of metabolism</a>. This suggests they can also affect many aspects of neuronal function and consequently affect which genes are expressed.</p>
<h2>Changing brain gene activity with lifestyle</h2>
<p>How addictive substances change cell function is complex. The version of a gene you’re born with can be modified in many ways before it becomes a functional protein, including exposure to alcohol and drugs. Rather than discouraging researchers, this complexity is empowering because it provides evidence that changes to gene expression in your brain aren’t permanent. They can also be altered by medications and lifestyle choices.</p>
<p>Many commonly prescribed medications for mental health disorders also affect gene expression. <a href="https://doi.org/10.1038%2Fs41398-019-0589-0">Antidepressants and</a> <a href="https://doi.org/10.1016/j.jpsychires.2013.05.028">mood stabilizers</a> can change how DNA is modified and which genes are expressed. For example, a commonly prescribed drug for depression called escitalopram affects how tightly wound DNA is and can change the expression of genes important to brain plasticity.</p>
<p>Additionally, <a href="https://theconversation.com/customizing-mrna-is-easy-and-thats-what-makes-it-the-next-frontier-for-personalized-medicine-a-molecular-biologist-explains-216127">mRNA-based therapies</a> can specifically change which genes are expressed to treat diseases like cancer. In the future, we may discover similar therapies for alcohol and substance use disorder. These treatments could potentially target important <a href="https://doi.org/10.1016%2Fj.tins.2021.09.006">signaling pathways linked to addiction</a>, altering how brain circuits function and how alcohol and drugs affect them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of person sitting with crossed legs on a yoga mat, hands resting on knees with pointer finger touching thumb" src="https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.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">Exercise and other lifestyle choices can affect gene regulation.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/indonesian-woman-is-meditating-in-a-half-lotus-royalty-free-image/1391023941?adppopup=true">Afriandi/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Lifestyle choices can also affect gene expression in your brain, though researchers don’t yet know whether they can alter the changes induced by addictive substances. </p>
<p>Like alcohol and drugs, <a href="https://theconversation.com/what-you-eat-can-reprogram-your-genes-an-expert-explains-the-emerging-science-of-nutrigenomics-165867">dietary changes</a> can affect gene expression in many ways. In flies, a high sugar diet can <a href="https://doi.org/10.1126/sciadv.abc8492">reprogram the ability to taste sweetness</a> by tapping into a gene expression network involved in development.</p>
<p><a href="https://doi.org/10.1016/j.cpnec.2022.100152">Intensive</a> <a href="https://doi.org/10.1016/j.psyneuen.2013.11.004">meditation</a>, even after only <a href="https://doi.org/10.1016/j.bbi.2019.11.003">one day</a>, can also affect gene regulation in your brain through similar mechanisms. Attending a <a href="https://doi.org/10.1016/j.cpnec.2022.100152">monthlong meditation retreat</a> reduces the expression of genes that affect inflammation, and experienced meditators can reduce inflammatory genes after just <a href="https://doi.org/10.1016/j.bbi.2019.11.003">one day of intensive meditation</a>. </p>
<p>Work in animal models has also shown that exercise changes gene expression by altering both <a href="https://doi.org/10.1016/j.brainres.2020.147191">histones</a> <a href="https://doi.org/10.1016/j.molmet.2021.101398">and the</a> <a href="https://doi.org/10.1111/j.1460-9568.2010.07508.x">molecular tags</a> directly attached to DNA. This increases the activity of genes important to the activity and plasticity of neurons, supporting the idea that <a href="https://theconversation.com/high-intensity-exercise-improves-memory-and-wards-off-dementia-127001">exercise improves learning and memory</a> and can decrease the risk of dementia.</p>
<p>From <a href="https://doi.org/10.1037/hea0000297">Dry January</a> and beyond, many factors can have profound effects on your brain biology. Taking steps to reduce consumption of alcohol and drugs and picking up healthy lifestyle practices can help stabilize and bring long-lasting benefits for your physical and mental health.</p><img src="https://counter.theconversation.com/content/220134/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karla Kaun receives funding from the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse and the National Institute of General Medical Sciences.</span></em></p>Improved understanding of the molecular mechanisms of addiction can change how researchers and clinicians approach treatments.Karla Kaun, Associate Professor of Neuroscience, Brown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2130852023-09-24T12:02:25Z2023-09-24T12:02:25ZYoung people with sexual or gender diversity are at higher risk of stopping their HIV treatment because of stigma and harsh laws<p>Ending the AIDS pandemic – particularly in eastern and southern Africa – cannot be achieved unless more resources are channelled to meet the needs of key vulnerable populations.</p>
<p>This is one of the themes that emerged during an <a href="https://www.samrc.ac.za/event/11th-sa-aids-conference-2023-20-23-june-2023-durban">AIDS conference in June</a> in South Africa. Prejudice against particular groups – such as men who have sex with men (MSM) and transgender communities – interferes with treatment regimes and people’s adherence to treatment. These groups are also at higher risk from HIV due to increased levels of stigma, discrimination, violence and criminalisation. </p>
<p>Our research is part of a three-year <a href="https://www.heard.org.za/wp-content/uploads/2023/06/SADC-Symposium-Report_final.pdf">project</a> on HIV-related stigma linked to young people with sexual or gender diversity. The research, conducted in Malawi, Zimbabwe and Zambia, involved 156 participants.</p>
<p>The research identified three main findings:</p>
<ul>
<li><p>Criminal laws and strongly negative socio-cultural and religious beliefs produced deeply rooted intolerance around sexual or gender diversity. </p></li>
<li><p>Participants spoke about repeated experiences of verbal harassment, being gossiped about and physical violence.</p></li>
<li><p>Other population groups with HIV said their lives had become more tolerable as social awareness and acceptance of HIV had increased over time. However HIV-related stigma regained its potency when linked to sexual or gender diversity, with adverse effects for adherence to antiretroviral treatment. </p></li>
</ul>
<p>Our research provided novel evidence on the deeply rooted fears and anxieties around multiple forms of stigma among young MSM and transgender women in southern Africa. </p>
<h2>Criminalising sex</h2>
<p>Across 13 countries in east and southern Africa, laws and policies criminalise same-sex sexual relations and facilitate the process of stigmatising gay and transgender individuals.</p>
<p>Recently, Uganda passed the Anti-Homosexuality Act of 2023, which punishes same-sex conduct with life imprisonment. Several acts considered as “aggravated homosexuality” are liable to the death penalty. </p>
<p>Our study also noted that young people had developed various strategies to manage their lives. For example choosing when to disclose or identify as a person living with HIV or as a member of the sexual minority community in others, but rarely being both at once. </p>
<p>The constant worry and stress of living with HIV, and the fear of being stigmatised, could have a significant impact on health and wellbeing. </p>
<p>The burden of concealing their identities resulted in a range of mental, emotional and physical vulnerabilities. Signs of depression as well as frequent alcohol use were evident.</p>
<p>Overall 42% of participants had contemplated suicide at least once. According to one participant, an 18-year-old:</p>
<blockquote>
<p>I feel like I am nothing, I am useless. In the community, looking at HIV, I am a gay, people they isolate me. So, I don’t feel comfortable, even failing to go to work and finding some money, whatever. And, sometimes, I decide if I can die today, I can rest. So, a lot of things come into my mind when I am disturbed … Sometimes my parents try to comfort me but, internally, I am really disturbed.</p>
</blockquote>
<p>As well as signs of depression, frequent alcohol use was evident. </p>
<p>There were few services available to assist in coping with these multiple stigmas, with those that came closest being provided by “sexual minority friendly” organisations or led by sexual minority peers themselves.</p>
<h2>Fear of being found out</h2>
<p>Being seen taking antiretroviral therapy or having it found in one’s possession signalled that one was living with HIV. Some individuals preferred to miss doses, occasionally or over more prolonged periods, rather than endure actual or feared stigma linked to being “found out” as someone living with HIV.</p>
<p>A 24-year-old told us:</p>
<blockquote>
<p>What made me to delay taking medication is when my partner wants me to visit his home because he stays in Zomba, and I haven’t disclosed my HIV status to my partner yet, and I can’t take the ARVs with me there. As a result, I go there without the ARVs.</p>
</blockquote>
<p>A 19-year-old said:</p>
<blockquote>
<p>It affects me sometimes because, if people reject you, you feel like stopping to take the medication. ‘Maybe am just wasting my time, let me just die.’ It affects me a lot.</p>
</blockquote>
<p>Other findings we made were that:</p>
<ul>
<li><p>Many participants had had their status disclosed by LGBTIQ+ peers without their consent. HIV-related stigma is still highly prevalent within the LGBTIQ+ community and has many negative impacts. </p></li>
<li><p>Participants continued to experience or fear stigma related to their sexual orientation at health facilities, which also affected their access to healthcare and retention in care.</p></li>
<li><p>Tailored HIV services for key populations, including young MSM and transgender women, were not reaching everyone; rural areas were the least included.</p></li>
<li><p>Through their experiences, gay young men and transgender women were familiar with the harmful consequences of stigma and yet they were often ostracised from planning and decision-making roles. </p></li>
</ul>
<h2>The way forward</h2>
<p>Key populations in our study faced inequalities in three main areas: access to HIV services; justice and human rights; and investments in programmes geared towards them.</p>
<p>There were few services available to assist in coping with these multiple stigmas. Those that came closest were provided by “sexual minority friendly” organisations or led by sexual minority peers themselves.</p>
<p>There need to be more community-based organisations that are run by members of these key populations. In Cameroon, for example, the <a href="https://www.usaid.gov/cameroon/health/hiv-aids">CHAMP</a> programme supports grassroots advocacy to mitigate stigma and violence and trains peers to offer counselling, </p>
<p>We can only achieve progress if we treat everyone as equal partners in fighting this pandemic.</p><img src="https://counter.theconversation.com/content/213085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaymarlin Govender receives funding from the National Research Foundation and Sida</span></em></p><p class="fine-print"><em><span>Patrick Nyamaruze receives funding from HIV/AIDS Special Fund Round III initiative of the Southern African Development Community. </span></em></p>Stigmatised people living with HIV often suffer from fear, depression and abuse. It’s sometimes easier to stop a treatment regime than risk being ostracised or assaulted by the community.Kaymarlin Govender, Research Director at The Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-NatalPatrick Nyamaruze, Post-doctoral research fellow, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103562023-07-28T12:19:42Z2023-07-28T12:19:42ZAs suicides rise in the US, the 988 hotline offers hope – but most Americans aren’t aware of it<figure><img src="https://images.theconversation.com/files/539383/original/file-20230725-21-y5cy7z.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4814%2C3639&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can call 988 for yourself, or for a friend or family member.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-using-phone-royalty-free-image/160077976?phrase=sad+young+person+on+phone&adppopup=true">Flashpop/Stone via Getty Images</a></span></figcaption></figure><p><em>July 2023 marks the one-year anniversary of the national launch of the <a href="https://988lifeline.org/">988 Suicide & Crisis Lifeline</a>. Currently, more than 200 call centers throughout the U.S. are responding to 988 calls. But few people know it exists. SciLine interviewed <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/12708">Dr. Emmy Betz</a>, a professor of emergency medicine at the University of Colorado, who discussed the critical need to raise awareness about 988, the increasing numbers of suicide deaths in the U.S. and the signs that someone is thinking about suicide.</em> </p>
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<figcaption><span class="caption">Emmy Betz discusses 988 and suicide prevention.</span></figcaption>
</figure>
<p><em>Below are some highlights from the discussion. Answers have been edited for brevity and clarity.</em></p>
<p><strong>Can you share some statistics about suicide in the U.S.?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide continues to be a <a href="https://www.cdc.gov/suicide/facts/index.html">leading cause of death</a> in the United States. In fact, it’s the 12th-leading cause of death among all ages. We had been seeing suicide rates rise from about 2000, up until around the COVID era. There was <a href="https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211105/20211105.htm">a small dip in rates</a> during those COVID years, which was great, but unfortunately we’ve now seen rates increase again. In 2021, there were 48,000 suicide deaths in the U.S., which is about one every 11 minutes.</p>
<p><strong>What about youth suicide?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide rates among youth in particular <a href="https://www.usnews.com/news/health-news/articles/2023-06-15/cdc-study-shows-rise-in-violent-death-rates-among-u-s-youth">have increased</a>. Between 2011 and 2021, suicide rates for youth rose 60%. Particularly concerning are increases in suicide rates among young individuals of color, where there have traditionally been lower suicide rates. </p>
<p><strong>Who should call 988, and when?</strong></p>
<p><strong>Emmy Betz:</strong> 988 is the suicide and crisis lifeline. I want to really emphasize, <a href="https://www.webmd.com/mental-health/features/988-suicide-prevention-overview">it’s not just for suicide</a>. It’s for anyone who’s experiencing substance abuse, mental health crisis, emotional distress or suicidal thoughts. You can call for yourself. You can call for someone in your family or a friend. It’s available 24/7, and it’s free and confidential.</p>
<p><strong>How has the first year of the 988 hotline gone?</strong></p>
<p><strong>Emmy Betz:</strong> In the first year, 988 answered <a href="https://www.samhsa.gov/sites/default/files/988-one-year-anniversary-issue-brief.pdf">nearly 5 million calls, chats or texts</a>. That’s great news. But one thing that I think is concerning: There was a Pew Charitable Trusts <a href="https://www.pewtrusts.org/en/research-and-analysis/articles/2023/05/23/most-us-adults-remain-unaware-of-988-suicide-and-crisis-lifeline">survey published in April 2023</a>. Only 13% of respondents said they knew both about 988 and what it was for. So I think we still have a ways to go in terms of raising awareness among people about what the hotline is, when you should call and then <a href="https://988helpline.org/what-to-expect/">what happens when you do call</a>.</p>
<p><strong>What are warning signs that a person is thinking about suicide?</strong></p>
<p><strong>Emmy Betz:</strong> It can vary. Sometimes, it can look like what we think of classically as depression – somebody who might seem sad, seems withdrawn and not doing the things that they previously have been wanting to do. </p>
<p>Certainly anything like talking a lot about death, mentioning suicide, mentioning not wanting to be around anymore – those are all very concerning. Some people, though, can seem angry or sort of ramped up or different. </p>
<p>The main thing to look out for is if someone says that they’ve lost hope or that they <a href="https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide">aren’t looking towards the future anymore</a>. </p>
<p>And perhaps the most important thing to know – it’s OK to ask. If you’re ever worried that someone might be having thoughts of suicide, <a href="https://suicideprevention.nv.gov/Youth/Myths/">it’s fine to ask them directly</a>. You’re not going to prompt suicidal thoughts by asking that question. </p>
<p><strong>What are some prevention strategies for firearm suicides?</strong></p>
<p><strong>Emmy Betz:</strong> Here at the University of Colorado, I lead the <a href="https://medschool.cuanschutz.edu/emergency-medicine/major-programs/firearm-injury-prevention-initiative">firearm injury prevention initiative</a>, which is a new program funded through the medical school that hopes to reduce all sorts of firearm injuries and deaths, including suicide. </p>
<p>Where I live in Colorado, 73% of our gun deaths are by suicide. It’s a <a href="https://coloradosun.com/2023/04/06/colorado-gun-violence-explained-charts/">critical problem in our state</a>. And these deaths are preventable.</p>
<p>Suicide typically occurs in the context of some kind of crisis, whether it’s related to a job, or a recent breakup with a romantic partner, or something else. Prevention is all about getting people through that high-risk period, to get the treatment or resources they need. </p>
<p>We know that if a person uses a firearm in a suicide attempt, about 90% of the time they die. So my work and the work of our initiative really focuses on how can we reduce firearm access when someone is in that high-risk period. </p>
<p>And importantly, it’s not about confiscation. It’s not about legislation. It’s about engaging with communities, educating communities and educating health care providers about what we can do to reduce firearm access – specifically, encouraging people to take steps to lock up guns differently, such as changing the locks or changing the password so the at-risk person can’t access the gun. </p>
<p>When someone has suicide risk, it can be a good idea to <a href="https://doi.org/10.1186/s40621-022-00389-3">move firearms out of the home temporarily</a>. We’ve been working with gun ranges, retailers and other locations that offer voluntary and temporary firearm storage as a solution for people – to make the home safer while someone’s getting better.</p>
<p>There are things we can do that don’t conflict with views on Second Amendment rights. I’m thrilled to see <a href="https://www.nssf.org/safety/suicide-prevention/nssf-afsp-partnership/">firearm rights organizations working with large organizations</a> like the Veterans Administration, the Department of Defense and medical organizations.</p>
<p><strong>What is suicide contagion, and what should journalists know about covering suicide without contributing to it?</strong></p>
<p><strong>Emmy Betz:</strong> Suicide contagion is the phenomenon whereby hearing about one suicide – in particular, the methods – leads to additional individuals <a href="https://time.com/5572394/suicide-contagion-study/">attempting or dying by suicide</a> using the same methods. </p>
<p>It’s really important that journalists talk about suicide, and that we raise awareness, and we get these messages out. But there are guidelines about how to reduce contagion. There are guidelines from the American Foundation for Suicide Prevention and other large organizations that <a href="https://afsp.org/safereporting/#:%7E:">really spell out best practices for journalists</a>. </p>
<p><em>Watch the <a href="https://www.sciline.org/mental-health/suicide-prevention/">full interview</a> to hear more about the 988 hotline and suicide prevention.</em> </p>
<p><em><a href="https://www.sciline.org/">SciLine</a> is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.</em></p>
<p><em>This article was corrected to fix the attribution for the April 2023 survey.</em></p><img src="https://counter.theconversation.com/content/210356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emmy Betz receives research grant funding from the National Institutes of Health and the Department of Defense. </span></em></p>The 988 Suicide & Crisis Lifeline is for anyone experiencing suicidal thoughts, emotional distress, substance abuse issues or mental health problems.Emmy Betz, Professor of Emergency Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2052332023-06-07T14:04:05Z2023-06-07T14:04:05ZFoetal alcohol syndrome: facial modelling study explores technology to aid diagnosis<figure><img src="https://images.theconversation.com/files/530314/original/file-20230606-17-xwgadc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advances in facial recognition technology may have useful applications in healthcare.</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>Foetal alcohol syndrome is a lifelong condition <a href="https://www.nhs.uk/conditions/foetal-alcohol-spectrum-disorder/">caused</a> by exposing an unborn baby to alcohol. It’s a pattern of mental, <a href="https://doi.org/10.1111/j.1469-7580.2006.00683.x">physical</a> and behavioural symptoms seen in some people whose mothers consumed alcohol during pregnancy. Not all prenatal alcohol exposure results in the syndrome; it is the most severe form of a range of effects called foetal alcohol spectrum disorders. </p>
<p>South Africa has the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710622/">highest reported rates</a> of <a href="https://theconversation.com/explainer-foetal-alcohol-spectrum-disorders-9871">foetal alcohol spectrum disorders</a> in the world: 111.1 per 1,000 population. The disorders may affect <a href="https://farrsa.org.za/library/#toggle-id-2">seven million</a> people in the country. The number could be higher because of under-diagnosis. </p>
<p>Foetal alcohol syndrome can’t be reversed. But confirmed diagnosis can have benefits. It can lead to early intervention and therapy (physical, occupational, and speech, among others), and a better <a href="https://farrsa.org.za/wp-content/uploads/2021/11/2021-FASD-Pamphlet-13-Sept-2021.pdf">understanding</a> from parents and teachers. Diagnosis can also ensure that adults are eligible for social services support. </p>
<p>Clinicians use a range of methods to <a href="https://publications.aap.org/pediatrics/article/138/2/e20154256/52445/Updated-Clinical-Guidelines-for-Diagnosing-Fetal">diagnose foetal alcohol syndrome</a>, including assessing abnormal growth and brain function. A key part of the process is looking at the individual’s facial features. Typical <a href="https://farrsa.org.za/library/#toggle-id-1">features</a> are small eye openings, a thin upper lip, and a smooth area between the nose and upper lip. </p>
<p>But visual examination of the facial features can be subjective and often depends on the clinician’s experience and expertise. Another challenge arises in low-resource settings when there aren’t many doctors specially trained to do this.</p>
<p>A more objective and standard way to detect foetal alcohol syndrome early would therefore be useful.</p>
<p>One method that’s being used to aid diagnosis is <a href="https://doi.org/10.1111/acer.14875">three-dimensional (3D) surfaces</a> produced by devices that scan the face. The technology is costly and complex. Two-dimensional (2D) images are easier to get – it can be done with a digital camera or smartphone – but are not accurate enough for diagnosis.</p>
<p><a href="https://doi.org/10.17159/sajs.2023/12064">Our study</a> sought to explore whether it was possible to use normal 2D face images to approximate 3D surfaces of the face. We showed that it was. Our method involved using 3D models that can change their shape based on a variety of real human faces, combined with 3D facial analysis technology.</p>
<p>We argue in our paper that our findings show the technology can improve early detection, intervention and treatment for people affected by foetal alcohol syndrome, particularly in low-resource settings. </p>
<p>We hope to contribute to the global effort to prevent and manage the lifelong consequences of the syndrome and disorders.</p>
<h2>How it would work</h2>
<p>We constructed a <a href="https://doi.org/10.1145/3395208">flexible 3D model</a> that can alter its shape based on a variety of real human faces. The changes are guided by statistical patterns learned from a <a href="https://www.cs.binghamton.edu/%7Elijun/Research/3DFE/3DFE_Analysis.html">dataset of high-quality 3D scans</a> from 98 individuals. This international open-source dataset was carefully curated to represent different demographic groups. </p>
<p>We didn’t have access to image data of individuals affected by foetal alcohol syndrome. We therefore used 2D and 3D images of individuals without this condition to develop and validate our approach. We nevertheless reasoned that our method should work equally well for any scenario where the model and the test subjects are closely matched. </p>
<p>We then set out to develop and validate a machine learning algorithm for predicting 3D faces of unseen subjects, from their 2D face images only, using our 3D model. </p>
<p>This was a pioneering step in our research, where we aimed to create a “smart” tool that could bring flat images to life in three dimensions. The results of the study were encouraging. </p>
<p>Our 3D-from-2D prediction algorithm performed well in three ways:</p>
<ul>
<li><p>capturing facial variations</p></li>
<li><p>representing unique features</p></li>
<li><p>summarising information of faces from 2D images. </p></li>
</ul>
<p>Since we had actual 3D face scans to use for comparison, we were able to calculate the average difference between these scans and the face shapes predicted by our model. This allowed us to measure the error in our fitting, which we found to be in <a href="https://doi.org/10.1109/TCYB.2014.2359056">line with other studies</a>. </p>
<p>We particularly focused on specific regions of the face: the eyes, midface, upper lip, and philtrum (the groove between the nose and the top lip). These regions provide crucial information for clinicians when examining the facial markers of foetal alcohol syndrome. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530325/original/file-20230606-28-vgz1xs.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Facial regions associated with foetal alcohol syndrome on a normal face.</span>
<span class="attribution"><span class="source">Tinashe Mutsvangwa</span></span>
</figcaption>
</figure>
<p>We could accurately predict these facial regions, and concluded from this that our method could form the foundation of an image-based diagnostic tool for foetal alcohol syndrome.</p>
<p>Our study also showed that the quality of our predictions was independent of skin tone. This is a crucial finding. <a href="https://doi.org/10.1179/1743131X14Y.0000000093">Certain 3D scanning technologies have been known to struggle with accurately capturing darker skin tones</a>. This issue is <a href="https://doi.org/10.1016/j.bjps.2019.05.002">being addressed</a>. Nevertheless, our findings gave us confidence that there was additional potential for use of our approach in diverse populations. </p>
<h2>Challenges</h2>
<p>We did identify some limitations. Access to 3D data of individuals with foetal alcohol syndrome remains a challenge. Future research could focus on reducing reconstruction errors to acceptable clinical standards by collecting and analysing larger datasets, including data from underrepresented populations.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/remembering-tania-douglas-a-brilliant-biomedical-engineer-academic-and-friend-161931">Remembering Tania Douglas: a brilliant biomedical engineer, academic and friend</a>
</strong>
</em>
</p>
<hr>
<p><em>Our study is a continuation of the work carried out in collaboration with the late renowned South African biomedical engineer, <a href="https://sajs.co.za/article/view/11067">Tania Douglas</a> of the University of Cape Town.</em></p><img src="https://counter.theconversation.com/content/205233/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tinashe Ernest Muzvidzwa Mutsvangwa receives funding from the South African National Research Foundation</span></em></p><p class="fine-print"><em><span>Bernhard Egger receives funding from the German research council. </span></em></p><p class="fine-print"><em><span>Felix Atuhaire received funding from European Commission; the South African Department of Science and Innovation; the South African National Research Foundation.</span></em></p>Key to diagnosing foetal alcohol syndrome is an assessment of certain facial features. A 3D facial scan is expensive but 2D images may offer a solution.Tinashe Ernest Muzvidzwa Mutsvangwa, Associate Professor of Biomedical Engineering, University of Cape TownBernhard Egger, Professor for Cognitive Computer Vision, Friedrich-Alexander-Universität Erlangen-NürnbergFelix Atuhaire, Lecturer, Mbarara University of Science and TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057002023-05-29T13:10:10Z2023-05-29T13:10:10ZDrink up, it’s closing time: South African study calculates that limiting opening hours will save lives<figure><img src="https://images.theconversation.com/files/527034/original/file-20230518-17-8xdcj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cristi Lucaci/Shutterstock</span></span></figcaption></figure><p>South Africans are among the heaviest drinkers in the world. The country has the highest per capita rate of <a href="https://www.who.int/publications/i/item/9789241565639">alcohol consumption</a> in Africa. Excessive drinking is especially widespread in the Western Cape. Research <a href="https://dgmt.co.za/wp-content/uploads/2023/02/Minumum-Unit-Pricing-Phase-1.1-Modelling-Impact-of-MUP-15112021-FINAL-1.pdf">estimates</a> that per capita alcohol consumption in the province is between 30% and 40% higher than the national consumption. </p>
<p>Alcohol use contributes to <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7771-4">over 200</a> different diseases, injuries and conditions. It is also a risk factor for gender-based violence and <a href="https://www.westerncape.gov.za/assets/departments/health/mortality_profile_2016.pdf">violent crime</a>. </p>
<p>In a bid to reduce alcohol-related harms in the province, the Western Cape government has <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">proposed</a> a policy to restrict trading hours for onsite alcohol consumption. International <a href="https://pubmed.ncbi.nlm.nih.gov/28647704/">research</a> shows that reducing trading hours is an effective way to curb alcohol consumption and its associated harms. This type of policy is also supported by the <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">World Health Organization</a>. </p>
<p>My colleagues and I at the University of Cape Town recently conducted a modelling <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">study</a>. We wanted to determine the health and economic impacts of restricting the hours of onsite alcohol consumption. </p>
<p>We considered three latest closing-time scenarios: midnight, 1am and 2am. Data for the model baseline was drawn from national surveys on alcohol consumption, the national treasury’s annual budget reviews and publications from Statistics South Africa and the South African Medical Research Council. </p>
<p>We estimated the impact of each of the proposed closing times on the number of cases and deaths associated with certain health conditions. The study also assessed the policy’s impact on alcohol expenditure, excise tax, value added tax and retail revenue. Finally we estimated the impact on the cost of combating alcohol-related crime in the Western Cape.</p>
<p>Our <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">results</a> make it clear that limiting the hours for onsite consumption of alcohol will save lives. It will also prevent alcohol-related diseases and injuries, and reduce hospital and crime prevention costs.</p>
<p>On the other hand, national tax revenue and revenue to the alcohol industry will decrease. </p>
<h2>The findings</h2>
<p>We looked at how the policy might affect public health costs of six alcohol-related conditions. We also factored in the hospital costs of treating these conditions. The conditions we looked at were: road injury; intentional injury; liver cirrhosis; HIV; TB; and breast cancer. </p>
<p>Model estimates suggest that all closing-time scenarios correspond to decreases in six areas. These are: </p>
<ul>
<li><p>alcohol consumption</p></li>
<li><p>number of deaths due to the six alcohol-related conditions</p></li>
<li><p>number of cases of these six conditions</p></li>
<li><p>hospital costs of these conditions</p></li>
<li><p>cost of combating alcohol-related crime</p></li>
<li><p>revenue from alcohol sales and alcohol taxation.</p></li>
</ul>
<p>We estimated how much lower the number of cases of the six conditions would be over the next 20 years. The cases averted were:</p>
<ul>
<li><p>163,800 to 453,000 under the midnight closing-time scenario </p></li>
<li><p>88,700 to 220,300 (1am scenario) </p></li>
<li><p>12,600 to 28,300 (2am scenario). </p></li>
</ul>
<p>Correspondingly, the total hospital cost saving over the next 20 years is between: </p>
<ul>
<li><p>R326.8 million and R890.2 million (midnight scenario)</p></li>
<li><p>R130.5 million and R381.2 million (1am)</p></li>
<li><p>and between R18.7 million and R46.0 million (2am). </p></li>
</ul>
<p>(At the time of publication the <a href="https://www.xe.com/currencyconverter/convert/?Amount=1&From=USD&To=ZAR">exchange rate</a> was R19.42 to the US$) </p>
<p>In the year following the policy’s introduction, tax revenue (excise and value added tax) on alcohol sales is expected to decrease by between R100 million and R333 million under a midnight closing-time scenario. Under the 1am scenario it would fall by between R54 million and R179 million. And in the 2am scenario tax revenue would fall by between R9 million and R27 million. </p>
<p>Retail revenue would decrease by between R328 million and R1,093 million (midnight closing time), between R176 million and R587 million (1am) and between R27 million and R89 million (2am).</p>
<h2>What this all means</h2>
<p>The Western Cape government has expressed a clear commitment to protecting health in the Alcohol Harms Reduction <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">White Paper</a>. Introducing uniform trading-time restrictions for onsite retailers of alcohol is a good first step. </p>
<p>A midnight closing time restriction is the most pro-health policy option.
A 2am closing time is the most pro-industry. But the <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">research</a> does suggest that, from a public health standpoint, the 2am closing time still represents a modest improvement on the status quo.</p>
<p>Applying <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">evidence-based policies</a> to reduce alcohol consumption is necessary to reduce alcohol-related harms and deaths. The possibility of limited economic costs should not be a deterrent to this policy objective.</p>
<p>The alcohol industry may also point to the direct, indirect and induced job losses resulting from this policy. Concerns about employment losses are genuine and valid. But employment losses are only one side of the issue and should be considered with caution. One needs to consider the overall effects of the policy on employment. Jobs will be created in sectors attracting new demand as people spend some of their money on goods and services other than alcohol. It is nearly impossible to predict the number of jobs that will be created directly because of the policy, or because of the lives saved and lengthened.</p>
<h2>What more needs to be done</h2>
<p>Whatever closing time the government chooses, this policy won’t solve every problem. It will need to be enacted alongside other policy interventions geared towards reducing alcohol consumption and its associated harms. </p>
<p>These policies <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">include</a> banning alcohol advertising; adopting a minimum alcohol unit price; reducing the legal limits for drinking and driving; and making it easier for people to get counselling and medically assisted treatment if they struggle with alcohol dependence.</p>
<p>A comprehensive policy framework that targets alcohol consumption at an individual and societal level will be required to combat alcohol-related illness and death, and the adverse health, economic and social consequences.</p><img src="https://counter.theconversation.com/content/205700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This modelling study on which this article is based was commissioned and funded by the DG Murray Trust, an organisation which Sam has collaborated with as a consultant. Sam Filby works for the Research Unit on the Economics of Excisable Products based at the University of Cape Town. Her research conducted at the University of Cape Town is funded by the African Capacity Building Foundation through the Bill & Melinda Gates Foundation, Tax Justice Network Africa (also through the Bill & Melinda Gates Foundation), the CDC Foundation, and Cancer Research UK. Sam is also CIO of byegwaai, an app-based smoking cessation program. </span></em></p>Alcohol use contributes to over 200 different diseases, injuries, and conditions. It is also a risk factor for gender-based violence and violent crime.Sam Filby, Research Officer, Research Unit on the Economics of Excisable Products, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041132023-04-27T20:17:20Z2023-04-27T20:17:20ZStudy reveals at least 11% of child maltreatment in NZ could be due to heavy drinking by caregivers<figure><img src="https://images.theconversation.com/files/522902/original/file-20230426-14-isrm2t.jpg?ixlib=rb-1.1.0&rect=160%2C103%2C3673%2C2052&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>More than one in ten children who are maltreated suffer because of the second-hand effects of alcohol, according to our recently published <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.16111">research</a>. </p>
<p>This is the first national cohort study in Aotearoa New Zealand focused on child maltreatment among children under 18 and alcohol use by adults caring for them. We estimate at least 11% of maltreatment could be due to hazardous or severe drinking among carers. </p>
<p>This is also the first study globally to examine all five domains of child maltreatment – physical abuse, neglect or abandonment, emotional or psychological abuse, sexual abuse and exposure to family violence – using data from child protection, hospitals and police linked to hazardous or severe alcohol consumption among parents. </p>
<p>Our findings show children exposed to this level of drinking among their caregivers have a 65% increased risk of maltreatment. But current alcohol policy does not reflect this. We argue it could play an important role in the prevention of harm to children. </p>
<h2>Alcohol and the risk of child maltreatment</h2>
<p>Carers who drink may be less vigilant, or cause conflict or violence. It is important to reduce this harm, given children are largely unable to remove themselves from the harmful environment. </p>
<p>We analysed data from 58,359 children aged 0–17 and their parents, from 2000 to 2017. Parents with hazardous or severe alcohol use were identified from hospitalisations or their use of mental health and addiction services, including community services.</p>
<p>Across all five domains of child maltreatment, 14% of children experienced at least one maltreatment event. This percentage was as high as 34% for emotional abuse. The next most common types were neglect and exposure to family violence in the household, both around 20%. </p>
<p>Hazardous or severe alcohol consumption among parents increased the risk of child maltreatment by 65%. </p>
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<strong>
Read more:
<a href="https://theconversation.com/major-study-reveals-two-thirds-of-people-who-suffer-childhood-maltreatment-suffer-more-than-one-kind-202033">Major study reveals two-thirds of people who suffer childhood maltreatment suffer more than one kind</a>
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<h2>The burden of alcohol on child maltreatment</h2>
<p>We also analysed data from one year – 2017. We found between 11.4% and 14.6% of child maltreatment could be due to hazardous or severe consumption among parents. This impact of alcohol on maltreatment is similar to traffic crash deaths caused by others drinking (13%), highlighting the size of the problem. </p>
<figure class="align-center ">
<img alt="A drunk adult with a child holding a teddy." src="https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522909/original/file-20230426-14-u13v67.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children born into a family with existing problems, including heavy drinking, face a higher risk of maltreatment.</span>
<span class="attribution"><span class="source">Shutterstock/M-Production</span></span>
</figcaption>
</figure>
<p>Hazardous alcohol exposure is involved in child maltreatment as part of a cluster of precipitating factors. This often reflects other types of adversities families experience. </p>
<p>In our study, the risk of child maltreatment was greater for children born into a family with already existing adversities, such as heavy use of other drugs, mental health issues or the mother’s age at childbirth. </p>
<p>If a family had a history of hazardous drinking, this accrued more risk for maltreatment than if the family developed alcohol problems as the child was growing up. Children from families with low education status had almost five times the risk of maltreatment, relative to families with high education status. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-new-zealand-must-consider-restricting-alcohol-sponsorship-of-broadcast-sports-as-part-of-a-wider-law-reform-193523">Why New Zealand must consider restricting alcohol sponsorship of broadcast sports as part of a wider law reform</a>
</strong>
</em>
</p>
<hr>
<p>We argue alcohol policy has a place in preventing child maltreatment related to alcohol. It is critical children receive more attention in the alcohol policy debate. </p>
<p>We know from <a href="https://global.oup.com/academic/product/Alcohol-no-ordinary-commodity-9780192844484">previous research</a> that increasing tax on alcohol, banning or reducing alcohol marketing and reducing the availability of alcohol will work to reduce heavy drinking among adults. This can, by default, protect children from the second-hand effects of alcohol. </p>
<p>These policies are cost-effective in reducing harm from alcohol and do not further burden child protection services. </p>
<h2>Lack of health regulations for alcohol</h2>
<p>There are challenges implementing effective alcohol policy. We still don’t have any internationally binding health regulations in place for alcohol. Alcohol remains the sole major addictive substance without such oversight. </p>
<p>The structure and practices of the alcohol industry, as with other industries producing and marketing unhealthy products, also play a crucial role in this challenge. </p>
<p>The primary source of contention between the alcohol industry and the public health community stems from the industry’s reliance on heavy consumption for sales and profits. This conflict of interest is a powerful motivator for industry interference in both <a href="https://global.oup.com/academic/product/Alcohol-no-ordinary-commodity-9780192844484">effective policy development and implementation</a>.</p>
<p>Nevertheless, children have rights to be protected from maltreatment (Article 19 of the <a href="https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/monitoring/uncroc/">UN Convention on the Rights of the Child</a>). Good public policy can reduce some of the burden of alcohol on child maltreatment, and also lessen prenatal exposure to alcohol and fetal alcohol spectrum disorder.</p><img src="https://counter.theconversation.com/content/204113/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taisia Huckle receives funding from The Health Research Council of New Zealand. </span></em></p><p class="fine-print"><em><span>Jose S. Romeo 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>Heavy use of alcohol by caregivers places children at increased risk of serious harm. This burden of alcohol-related maltreatment is similar to traffic deaths caused by others drinking.Taisia Huckle, Associate Professor in alcohol policy, Massey UniversityJose S. Romeo, Senior Research Officer and Statistician, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1975362023-04-24T20:05:31Z2023-04-24T20:05:31ZTreatment for drug and alcohol misuse should involve families and communities<figure><img src="https://images.theconversation.com/files/520696/original/file-20230413-20-wbj5o4.jpg?ixlib=rb-1.1.0&rect=36%2C18%2C6049%2C2010&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Alcohol and other drug treatment in Australia is generally only provided for individuals, often away from their families. </p>
<p>Treatment can include withdrawal from the substance, counselling and residential rehabilitation. <a href="https://www.health.gov.au/sites/default/files/new-horizons-review-of-alcohol-and-other-drug-treatment-services_0.pdf">All these treatments</a> work to improve health and wellbeing and reduce the harms from substances.</p>
<p>But people’s families and communities can <a href="https://pubmed.ncbi.nlm.nih.gov/21707469/">influence</a> substance use and have the potential to <a href="https://www.tandfonline.com/doi/abs/10.1300/J160v06n01_01">aid the healing journey</a> of people in treatment.</p>
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Read more:
<a href="https://theconversation.com/why-do-some-people-struggle-to-make-healthy-decisions-day-after-day-147666">Why do some people struggle to make 'healthy' decisions, day after day?</a>
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<p>For a lot of First Nations peoples, health and wellbeing is not just about the individual. It’s <a href="https://www.telethonkids.org.au/globalassets/media/documents/aboriginal-health/working-together-second-edition/working-together-aboriginal-and-wellbeing-2014.pdf">interconnected</a> with family, culture, belonging and Country. </p>
<p>That’s why treatment services such as <a href="https://qnada.org.au/location/pinangba-cape-york-family-centre/">Pinangba</a> in Queensland – a First Nations alcohol and other drug service whose approach we have been researching – includes families, culture and Country in treatment. </p>
<p>This way of pursuing treatment should be available for everyone.</p>
<h2>The role of families in treatment</h2>
<p>Families and community can play an essential role in giving up alcohol and other drugs and avoiding relapse. <a href="https://vsu.mhc.wa.gov.au/media/1301/dha-2.pdf">Research shows</a> advice or encouragement from family members is an important reason for giving up or reducing problematic substance use.</p>
<p>However, some people who attend treatment facilities alone often <a href="https://www.tandfonline.com/doi/abs/10.1080/0312407X.2010.508841?journalCode=rasw20">have limited support</a> back home in their communities to maintain sobriety or reduced consumption. </p>
<p>Family and communities do not always have the right tools to support the individual in treatment, and some family members may experience problematic substance use themselves.</p>
<figure class="align-center ">
<img alt="Couple hugging" src="https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520704/original/file-20230413-14-qb9cml.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Family members may not have the tools to support a loved one after treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/loving-couple-sitting-together-garden-party-2117549252">Shutterstock</a></span>
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<h2>What happens at Pinangba?</h2>
<p>Pinangba is an Indigenous-led residential rehabilitation service in Queensland. It’s one of a small number of alcohol and other drug treatment services in Australia that take in the entire family unit of adults and children for the residential stay. </p>
<p>Pinangba adopts a <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1752-0606.2011.00280.x?casa_token=RNglVnXOJ0gAAAAA:0e99cXjUl_DDP_Kp_j-R2dxlJ1TUFQm2TY4BPHh2uPN57D5trUPmr-4h28hjyKY47e1P1o4GNWt7giIt">systemic family therapy model</a>. The therapist is invited to consider not only the context of the individual within their family but also consider the context of the family in relation to the broader social, political and historical systems.</p>
<p>There is an emphasis on building, strengthening and repairing relationships as part of the healing work of the client. </p>
<p>Pinangba also considers the environments most influential in a client’s life (social services, work, court) that may impact their healing journey. </p>
<p>Its family-based approach helps clients to engage and stay in treatment, stay abstinent and improve relationships. This approach also positively impacts the alcohol and other drug use of other family members and improves the functioning of their children. </p>
<p>Pinangba family therapy approach to addiction has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13537">positively received</a> by clients, families, community, and other health and social service providers.</p>
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<p>
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<strong>
Read more:
<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">Alcohol problems aren't for life, and AA isn't the only option. 8 things film and TV get wrong about drug and alcohol treatment</a>
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<p>Non-Indigenous people also benefit from this model. Family-focused interventions for non-Indigenous people with substance use issues have <a href="https://www.tandfonline.com/doi/abs/10.1080/1533256X.2019.1659068?journalCode=wswp20">been effective</a> for both young people and adults. Not only do these interventions reduce substance use, they also improve family functioning compared to individual-based treatment. </p>
<p>Despite these positive outcomes, family-focused interventions within alcohol and other drug services is still uncommon. </p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/1533256X.2019.1659068?journalCode=wswp20">Barriers to implementation</a> are not only related to the individualised treatment focus, but also to issues such as difficulties of involving family in treatment, limited staff time, lack of experience and insufficient training. </p>
<figure class="align-center ">
<img alt="Corridor" src="https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520708/original/file-20230413-16-yujzdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A number of barriers need to be overcome to roll it out more widely.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-interior-corridor-bue-greece-1256860270">Shutterstock</a></span>
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<h2>Expanding access 3 ways</h2>
<p>For this family-focused model of care to be incorporated into both Indigenous and non-Indigenous alcohol and other drug services we need better data collection and better funding. Here are three important steps towards this implementation: </p>
<p><strong>1. Careful evaluation of programs with family engagement, family therapy and holistic treatment.</strong> </p>
<p>There is currently little knowledge about the effectiveness of this model for First Nations people. That is exactly what we are doing with Pinangba: with funding from the <a href="https://www.qmhc.qld.gov.au/sites/default/files/qmhc_2020-21_annual_report_accessible_web.pdf">Queensland Mental Health Commission</a> we are building an evaluation integrated into routine service delivery, to demonstrate how such holistic, family-oriented treatment works. </p>
<p>It is vital that data are collected as part of routine practices so an evidence-base can be built up.</p>
<p><strong>2. Routine data collection practices that does not rely on external funding.</strong> </p>
<p>Organisations that fund alcohol and other drug treatment for First Nations peoples (including the Commonwealth, Primary Health Networks and state governments) should ensure funding levels adequate so services can spend time collecting and entering data on client progress and outcomes. </p>
<p>This is currently not the case. Collecting evaluation data is seen as an added extra, not as an essential part of ongoing service delivery. This needs to change.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">What is 'success' in drug rehab? Programs need more than just anecdotes to prove they work</a>
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<p><strong>3. Funding that looks beyond individual models of care.</strong></p>
<p>Newer ways of working, where families become the “treatment unit” will involve new costs, new buildings, new ways of working, new data collection, and will require more funding and planning. </p>
<p>If we were really thinking about families, we need to think about treatment with a family, not an individual. This shift in thinking needs to occur across all levels of the system.</p><img src="https://counter.theconversation.com/content/197536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katinka van de Ven receives funding from state and territory governments including the Queensland Mental Health Commission.</span></em></p><p class="fine-print"><em><span>Alison Ritter receives funding from the NHMRC, the ARC, and state/territory governments. </span></em></p><p class="fine-print"><em><span>Erin Cunningham receives funding from Queensland Mental Health Commission for the Pinangba Research Project. </span></em></p>Alcohol and drug addiction impacts families as well as the people afflicted. Some First Nations-led centres involve families in their patients’s treatment, with beneficial outcomes.Katinka van de Ven, Alcohol and other drug specialist, University of New South Wales &, University of New EnglandAlison Ritter, Professor & Specialist in Drug Policy, UNSW SydneyErin Cunningham, Pinangba Support Officer, Indigenous KnowledgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992312023-02-20T16:32:43Z2023-02-20T16:32:43ZHow queuing leads to city centre violence and what our research says about preventing night-time brawls<p>People go out at night because they want to socialise, drink and be entertained. Unfortunately, all too often that leads to violent behaviour in our towns and city centres. But the events that lead to such violence are poorly understood. </p>
<p>We set out to explore some of the possible explanations of night-time violence using data on Cardiff city centre footfall (the number of people in the city centre) and assault-related attendances at the nearby University Hospital of Wales. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779416/">We found</a> that a break down in the unwritten etiquette of queuing may be one of the reasons behind increases in violence at night.</p>
<p>When revellers gather to enjoy themselves at night, they often drink alcohol and possibly take drugs. This typically sets the activity apart from other places where people gather, such as transport centres or places for other commercial activity such as shopping. </p>
<p>People are attracted to night-time environments based on the <a href="https://journals.sagepub.com/doi/abs/10.1177/004728759303200204">total number of social opportunities they provide</a>, whether it’s going clubbing or visiting pubs. So, while entertainment venues compete against one another for trade, they also collectively market to attract patrons from near and far.</p>
<p><strong>The relationship between footfall and assault related injuries</strong></p>
<figure class="align-center ">
<img alt="A graph showing days of the week on the horizontal axis and numbers on both vertical axes. A line loops up and down." src="https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508108/original/file-20230203-2880-nenoi7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A graph showing the relationship between footfall and assault related injuries.</span>
<span class="attribution"><span class="source">author provided</span></span>
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</figure>
<p>There has been plenty of research into what reduces or promotes night-time violence in city centres. One of the clear signals of danger is that the larger the footfall in the area, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779416/">the larger the chance for assaults to occur</a>. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1359178908000451?via%3Dihub">Crowding</a> and <a href="https://link.springer.com/article/10.1057/cpcs.2012.12">noise</a> are associated with increases in violence in city centres at night. And, in Australia, it has been shown that when <a href="https://www.tandfonline.com/doi/full/10.1080/10826084.2021.2019772">trading hours are restricted</a> there is a <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12123">decrease in violence</a>.</p>
<p>But our research shows the correlation between footfall and assault is not linear. In other words, if we double the footfall, we do not simply double the number of assaults. The relationship between these two factors is more complicated, so we decided to investigate what could account for that.</p>
<h2>Queue etiquette</h2>
<p>One particular aspect we considered was the role drunkenness has to play because it <a href="https://royalsocietypublishing.org/doi/full/10.1098/rstb.2008.0028?casa_token=m93tA6ou_hwAAAAA:BprjJMUf5LNgIp6ftJlEBAnpBA-rAIQMvv6gvvCh4-wtDDkZFtYAN8LRNdVRDs2CCS7U8EkiV4PzGQ">affects how people cooperate</a>, for example when queuing. Queues are a social response to resource competition, whether that resource is nightclub entry, a pint of beer or a taxi. </p>
<p>However, since queuing is a social phenomenon, the people waiting in line have <a href="https://pubsonline.informs.org/doi/abs/10.1287/opre.35.6.895">expectations about how others should behave</a>, such as not skipping to the front. </p>
<p>When a violation of those unwritten rules occurs, people queuing in an orderly fashion will seek to defend the queue’s order, with the most vocal complaints stemming from those who are <a href="https://psycnet.apa.org/buy/1987-04011-001">closest to where the person jumps into the line</a>. Although even those ahead of the intrusion <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1559-1816.2008.00396.x?casa_token=xrR27tjG5jcAAAAA%3A-ub-j1Onmr9Senw4N2aGVljAgfifCQvqv_qWTGqPbTm437LilyojU30Mq1vyB2X_lOv3A_KMxLiSPo8">may also react to the injustice</a>. </p>
<p>However, whether there’s a queue violation or not, waiting in line makes people stressed. This increases <a href="https://link.springer.com/article/10.1177/0092070396244005">the longer they believe they have been waiting</a>. In turn, such stress can lead to aggression.</p>
<p>To understand the role queues play in the relationship between footfall and assault, we used a mathematical model to help predict what would happen in a variety of night-time scenarios. </p>
<p>We assumed the average arrival time of people into a queue is constant. We also assumed the rate at which they are served and leave the queue is constant, but also rises and falls in line with the number of servers, such as bar staff, taxi drivers or similar. </p>
<p>We also adjusted the models to take account of various other factors, such as weather, bank holidays and whether there were Six Nations or other international rugby matches being played at Cardiff’s Principality Stadium.</p>
<p>We found there was a significant relationship between the number of people in the city centre and the number of assaults recorded in the hospital’s accident and emergency department. The relationship relating footfall with assaults we saw from our queuing models performed better than the simple linear relationship. This is why doubling footfall does not double assaults.</p>
<p>Our study also found events such as bank holidays and rugby matches led to an increase in violence, beyond what might be expected from the impact of footfall alone. Additionally, warmer weather also increased the likelihood of assaults but more rain did not have a significant effect.</p>
<h2>Cutting city centre violence</h2>
<p>Our mathematical models show that by reducing queuing time, stress and related violence drops too. The average waiting time drops dramatically as the number of servers increases. So when pubs, taxi services or similar are understaffed, that increases the competition between people queuing.</p>
<p>The <a href="https://www.legislation.gov.uk/ukpga/2003/17/contents">UK Licensing Act 2003</a> places a duty on licensed premises to prevent crime and disorder and to maintain public safety. But there are no provisions on how licensed activity should increase as the number of patrons increases. </p>
<p>If further research confirms our observations, then there is a need to address the design and operation of night-time services, not only of bars, but of other areas where queues of revellers might form, such as taxi ranks and fast food outlets.</p><img src="https://counter.theconversation.com/content/199231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James White receives funding from the NIHR, MRC, Health and Care Research Wales, Scottish Chief Scientist Office, and Department for Education. </span></em></p><p class="fine-print"><em><span>Simon C Moore receives funding from NIHR, Youth Endowment Fund, ESRC, MRC. </span></em></p><p class="fine-print"><em><span>Thomas Woolley 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>Recent research shows how the relationship between alcohol consumption, queuing and crowds can lead to violent behaviour in city centres at night.Thomas Woolley, Senior Lecturer in Applied Mathematics, Cardiff UniversityJames White, Chair professor, Cardiff UniversitySimon C Moore, Professor of Public Health Research, Co-Director of Crime and Security Research Institute and Director of the Violence Research Group, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950982022-12-15T22:21:29Z2022-12-15T22:21:29ZWant to pre-drink before going out? It probably won’t save you money, and can be risky to boot<figure><img src="https://images.theconversation.com/files/497578/original/file-20221128-16-ee63oq.jpg?ixlib=rb-1.1.0&rect=0%2C194%2C4104%2C2544&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Louis Hansel/Unsplash</span></span></figcaption></figure><p>You’re catching up with a few friends before you go out. Everyone’s having a drink, listening to some tunes, and the mood is good. A ride share is pulling up in the driveway – everyone quickly finishes their drinks and piles into the car, headed to a gig where more alcohol will be consumed. </p>
<p>This is the typical pre-drinking scenario – drinking alcohol in one place, typically someone’s home, before drinking more somewhere else, such as a pub, club or event.</p>
<p>You might be familiar with pre-drinking (colloquially known as <a href="https://www.vichealth.vic.gov.au/media-and-resources/media-releases/experts-warn-against-preloading-on-alcohol-ahead-of-schoolies-week">pre-loading</a>) and think nothing much of doing it.</p>
<p>In reality, it’s a complex behaviour that has been of great interest to health psychologists and public health strategists <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12525">for the past 15 years</a>.</p>
<p>And as popular as it is, pre-drinking isn’t without risk.</p>
<h2>Why do people pre-drink?</h2>
<p>The considerable public health effort to reduce excessive drinking in licensed venues has meant some drinkers appear to have abandoned the traditional “pub to club” model in favour of a “<a href="https://www.emerald.com/insight/content/doi/10.1108/17459261211235119/full/html">home to pub to club” version</a>.</p>
<p>You can understand the appeal – compared to a busy venue, someone’s house is likely to be less noisy, less cramped, and probably doesn’t include a cover charge.</p>
<p>In Australia, a common reason people cite for pre-drinking is the relatively cheaper cost of pre-purchased alcohol compared with prices at a licensed venue.</p>
<p>Indeed, behavioural economists have observed <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13254">we tend to be quite discerning</a> when figuring out the most cost-effective way to drink.</p>
<p>Add our <a href="https://www.ato.gov.au/business/excise-on-alcohol/lodging,-paying-and-rates---excisable-alcohol/excise-duty-rates-for-alcohol/">complex taxation system</a> and public health initiatives such as <a href="https://industry.nt.gov.au/publications/business/policies/floor-price">minimum unit pricing</a> to the mix, and it’s no surprise we are looking for ways to get a buzz on the cheap.</p>
<h2>More than money?</h2>
<p>Outside Australia, evidence shows alcohol price is less of a driver for pre-drinking. <a href="https://link.springer.com/chapter/10.1007/978-3-030-66941-6_13">Other motivational themes</a> have emerged – mainly from psychological research in North America and Europe. </p>
<p>These include the “enhancement” aspect of pre-drinking itself (as the opening scenario illustrates), controlling alcohol consumption in situ (such as only drinking your preferred brand), or in anticipation of less access to alcohol later on (think long lines for beer at the footy).</p>
<p>Generally, the aim of pre-drinking appears to be getting “sufficiently intoxicated” before going out.</p>
<p>But one motive, commonly mentioned by men, has been labelled as “<a href="https://www.sciencedirect.com/science/article/pii/S0306460315000829">intimate pursuit</a>”. This is where hanging out during pre-drinks is used to built rapport with someone you might be romantically interested in. </p>
<p>Although these themes are generally endorsed by Australian pre-drinkers, cost is still an important driver of our pre-drinking, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12138">especially among young Australians</a>.</p>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<p>In <a href="https://link.springer.com/article/10.1007/s10865-014-9573-6">our research</a>, we asked participants about the cheaper cost of pre-drinking, alongside these other motives. It was the strongest predictor of pre-drinking, and also predicted participants’ experience of alcohol-related harm over the previous 12-month period.</p>
<p>Surprisingly, some people report that pre-drinking <a href="https://www.emerald.com/insight/content/doi/10.1108/DAT-12-2013-0055/full/html">doesn’t save them that much money</a>. </p>
<p>From a psychological perspective, this may be because alcohol affects our “<a href="https://link.springer.com/article/10.1007/s00213-008-1284-7">inhibitory control</a>”. Although our goal with having pre-drinks is to keep total alcohol expenditure down, the drunker we get, the harder it is to resist buying another round.</p>
<h2>The unique harm of pre-drinking</h2>
<p>Unfortunately, research consistently shows pre-drinking is uniquely linked to excessive alcohol consumption, and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12274">alcohol-related harm</a>.</p>
<p>One reason may be that <a href="https://pubmed.ncbi.nlm.nih.gov/18387749/">we drink faster while pre-drinking</a>, relative to sitting on a pint at the pub. This means pre-drinkers may reach higher levels of intoxication, more quickly.</p>
<p>This can be <a href="https://www.sciencedirect.com/science/article/pii/S0306460312003334">highly dependent on a range of factors</a> – for instance, who we are pre-drinking with, and whether or not people are playing drinking games.</p>
<p>Adding to the risk, people tend to be pretty bad at <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1465-3362.2011.00374.x">estimating how much they are drinking</a>. </p>
<p>Sadly, the “sweet spot” of a buzz can quickly give way to increasing levels of alcohol intoxication – and increased risk of alcohol-related harm. </p>
<figure class="align-center ">
<img alt="close-up of friends clinking four beers together" src="https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497788/original/file-20221128-20-4gf988.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">The more you’ve had to drink, the harder it can be to keep track.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/_8KV86shhPo">Giovanna Gomes/Unsplash</a></span>
</figcaption>
</figure>
<h2>How can pre-drinking risks be minimised?</h2>
<p>Research shows pre-drinking serves important practical and social functions – catching up with friends in a more relaxed environment, and warming up for a night out.</p>
<p>As such, it is unlikely we will eliminate pre-drinking entirely, but we can try to make it a bit less risky. </p>
<p>One challenge for pre-drinking is that people may drink out of whatever vessel is around – say, a mug – and will <a href="https://www.ingentaconnect.com/content/ben/cdar/2008/00000001/00000002/art00007">find it difficult</a> to keep track of their consumption.</p>
<p>Licensed premises serve alcohol in standardised containers such as pints and schooners, or use measured pours. So, having schooners or jiggers on hand when pre-drinking would be a good place to start.</p>
<p>Health psychologists often promote “protective behavioural strategies” – things that help keep our alcohol consumption under control. For example, we can set ourselves a drink limit, or set a timer between drinks to slow our intake. <a href="https://www.tandfonline.com/doi/10.1080/10826084.2019.1686025">Work is ongoing</a> to investigate how these strategies might be better tailored to the pre-drinking context.</p>
<p>Ultimately, if you’re planning a pre-drinking session before an event, it’s a good idea to make sure there are plenty of non-alcoholic or low-alcohol options, and food – <a href="http://www.safeparty.com.au/party-safe-for-hosts/">as you would with any party</a>.</p>
<p>The most important thing pre-drinkers can do is keep an eye on each other, making sure everyone makes it to the event, has a good time, and gets home safely.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-are-embracing-mindful-drinking-and-the-alcohol-industry-is-also-getting-sober-curious-160931">Australians are embracing 'mindful drinking' — and the alcohol industry is also getting sober curious</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/195098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kim M Caudwell 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>You might think it’s fine to have a few with friends before heading for a night out, but alcohol-related harms actually increase with pre-drinking.Kim M Caudwell, Lecturer - Psychology | Chair, Researchers in Behavioural Addictions, Alcohol and Drugs (BAAD), Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1835822022-07-25T12:07:55Z2022-07-25T12:07:55ZAlcohol use more likely among Black youths at racially segregated schools<figure><img src="https://images.theconversation.com/files/467714/original/file-20220608-25-5i4dwt.jpg?ixlib=rb-1.1.0&rect=20%2C20%2C4580%2C3400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Could structural racism in U.S. schools lead more young African Americans to drink?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/jet-of-a-bottle-of-cold-beer-of-crystal-on-a-black-royalty-free-image/584320758?adppopup=true">Jose A. Bernat Bacete / 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>Black youths who attend racially segregated schools are more likely to have drinking and behavior problems during childhood than Black youths in less segregated schools. This is according to a <a href="https://doi.org/10.1542/peds.2021-055952">new study</a> we conducted using <a href="https://psidonline.isr.umich.edu/GettingStarted.aspx">national survey data</a> from 1997 to 2014.</p>
<p>School segregation, defined as the physical separation of students in schools based on their race, was ruled unconstitutional in 1954 as part of the U.S. Supreme Court’s <a href="https://www.history.com/topics/black-history/brown-v-board-of-education-of-topeka">Brown v. Board of Education</a> decision. Consequently, about 1,000 districts nationwide were under court orders to desegregate. </p>
<p>However, school segregation <a href="https://www.pbs.org/wgbh/frontline/article/the-return-of-school-segregation-in-eight-charts/">has increased since 1991</a>, when the first of a series of <a href="https://doi.org/10.1002/pam.21649">court decisions</a> allowed districts to be released from court-ordered desegregation. Highly segregated schools – where less than 10% of students are white – <a href="https://www.civilrightsproject.ucla.edu/research/k-12-education/integration-and-diversity/brown-at-62-school-segregation-by-race-poverty-and-state/Brown-at-62-final-corrected-2.pdf">increased from 5.7% to 18.6% of all schools</a> – from 1988 to 2013. </p>
<p>Our study is among the first to explore how this recent segregation affects the health of Black children. It examines whether the health of Black children in districts that were released from court-ordered desegregation earlier is different from those in districts released later. </p>
<p>Our research team analyzed data on school segregation levels and health outcomes for about 1,248 Black children ages 5 to 17. We measured school segregation using the dissimilarity index, which indicates the proportion of Black or white students who would need to move to a different school to make all schools in a school district have the same student racial distribution.</p>
<p>We found that the more segregated a school district, the more likely Black students were to have behavioral problems, and the more likely Black students older than 12 years were to drink alcohol. For Black girls, the more segregated the school, the likelihood of having drunk alcohol rose at twice the rate it did for Black boys.</p>
<p><iframe id="trYy3" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/trYy3/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why it matters</h2>
<p>Earlier studies about school desegregation in the 1960s and 1970s found that it led to improvements in Black people’s well-being, such as <a href="https://doi.org/10.3386/w16664">higher educational and occupational attainment, better self-rated health</a> and <a href="https://doi.org/10.1016/j.socscimed.2011.12.029">reduced teen pregnancy rates</a>.</p>
<p>Yet some scholars have argued that segregated schools can have certain <a href="https://doi.org/10.7758/rsf.2021.7.1.10">benefits</a>. For example, school segregation may have protective effects as Black youths in predominantly Black schools may face less interpersonal racism from white students and teachers than if they went to desegregated schools. </p>
<p>On the other hand, school segregation is a manifestation of structural racism, such that highly segregated schools are often <a href="https://www.jstor.org/stable/10.5149/9780807876770_boger">underfunded, with more crowded classrooms</a>, less experienced teachers and high teacher turnover. Segregated schools also tend to have <a href="https://www.msnbc.com/msnbc/brown-v-board-students-criminalized-msna324866">harsher school discipline</a>.</p>
<p>These stressful environments can increase mental and emotional challenges for Black youths, making them more likely to develop unhealthy coping behaviors like drinking alcohol. In addition, segregated schools are more likely to be in segregated neighborhoods, which are more often <a href="https://doi.org/10.1016/s0277-9536(00)00004-6">targeted for alcohol advertising and have substantially more liquor stores</a>, making it easier for Black youths to obtain alcohol.</p>
<p>The results of our study suggest that the effects of structural racism and low school resources in segregated schools may be greater than the potential for reduced interpersonal racism. </p>
<h2>What still isn’t known</h2>
<p>This study did not examine why well-being was worse among Black youths in more segregated schools. For example, it didn’t examine whether it was because of fewer school counselors, higher stress levels or broader systemic factors. It also did not examine health among other groups like white, Hispanic or Asian children. </p>
<h2>What’s next</h2>
<p>Our team’s next steps are to explore the reasons school segregation affects young people’s well-being, not only for Black youths but also for white youths and other youths of color. Additionally, we plan to examine the long-term impact of school segregation as children transition to adulthood.</p><img src="https://counter.theconversation.com/content/183582/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rita Hamad receives funding from the National Institutes of Health and the Robert Wood Johnson Foundation.</span></em></p><p class="fine-print"><em><span>Guangyi Wang 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>An analysis shows that Black students at more racially segregated schools have a greater tendency to turn to the bottle.Guangyi Wang, Research Specialist, University of California, San FranciscoRita Hamad, Associate Professor of Family Community Medicine, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1863962022-07-08T14:13:48Z2022-07-08T14:13:48ZTavern tragedy reinforces need to give priority to tackling underage drinking in South Africa<figure><img src="https://images.theconversation.com/files/472810/original/file-20220706-21-vu70kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The cause of the deaths of 21 young people in a South African pub is still unclear.</span> <span class="attribution"><span class="source">STR/AFP via Getty Images</span></span></figcaption></figure><p>On 26 June 2022, <a href="https://www.dispatchlive.co.za/news/2022-07-02-full-coverage-of-the-enyobeni-tavern-tragedy/">21 young people died</a> at the Enyobeni tavern in East London, in South Africa’s Eastern Cape province. The incident refocused public attention on the safety of young people in the country. </p>
<p>The direct cause of the 21 deaths has not yet been determined. But questions are being asked about why children under the age of 18 were consuming alcohol in the tavern. </p>
<p>Questions about teenage alcohol consumption are particularly pertinent given how frequent alcohol use is among young people in South Africa and the considerable harm caused by underage drinking. <a href="https://www.wits.ac.za/media/wits-university/research/coe-human/documents/ChildGauge2019.pdf#page=216">One third</a> of the South African population is under the age of 18.</p>
<p>A 2011 <a href="https://repository.hsrc.ac.za/handle/20.500.11910/2487">national survey</a> of learners in grades 8 to 11 found that 37% of males and 28% of females reported drinking in the past 30 days. An alarming 30% of male and 20% of female learners reported binge drinking during the same period. A more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617861/">recent survey</a> in the Western Cape found that 5.6% of first-year university students reported an alcohol use disorder in the past 12 months.</p>
<p>The latest <a href="http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/2022/Child%20Gauge%202021_FINAL_screen.pdf">Child Gauge</a> report drew attention to a number of child and adolescent health issues. The publication gives an annual snapshot of the situation of children in South Africa. Some of the issues highlighted were the problems associated with underage drinking and the need for public and government action to safeguard young people. </p>
<p>Globally, alcohol is a <a href="https://www.sciencedirect.com/science/article/pii/S0140673612617668?via%3Dihub">leading risk factor</a> for death and disability among adolescents aged 15 to 19 years. South Africa is <a href="https://repository.hsrc.ac.za/handle/20.500.11910/2487">no exception</a>. Several factors shape the patterns of alcohol use. These include the accessibility and affordability of alcohol as well as indiscriminate marketing. This highlights the need for <a href="https://bmjopen.bmj.com/content/11/8/e052879">child-centred laws</a> that restrict access to alcohol, regulate marketing and establish minimum unit pricing.</p>
<h2>Drivers and impact</h2>
<p>Adolescent alcohol consumption is driven by <a href="https://www.sciencedirect.com/science/article/pii/S1353829211002097?via%3Dihub">several factors</a>. These include the availability of alcohol and social norms. The media also play an influential role in young people’s drinking habits. </p>
<p>Young people are prolific consumers of media. They are frequently exposed to alcohol advertising and marketing. This marketing encourages the consumption of alcohol. It also perpetuates the idea that drinking is safe and normal. </p>
<p>Adolescents are vulnerable to the harmful effects of <a href="https://www.jsad.com/doi/10.15288/jsads.2020.s19.42">alcohol advertising</a>. Research <a href="https://onlinelibrary.wiley.com/doi/10.1111/acer.13477">suggests</a> that they may be disproportionately exposed to marketing by alcohol producers. Exposure to alcohol marketing has been <a href="https://academic.oup.com/alcalc/article/44/3/229/178279">shown</a> to get young people to drink at younger ages and in greater quantities. Voluntary advertising industry guidelines and self-regulation are <a href="https://onlinelibrary.wiley.com/doi/10.1111/add.13410">not adequate</a> to protect young people. This highlights the importance of – and urgent need for – government oversight in this area.</p>
<p>Adolescent drinking has harmful direct and indirect <a href="https://doi.org/10.1016/j.pbb.2020.172906">consequences</a>. These include rape, interpersonal violence, absenteeism, school failure, unwanted pregnancies, sexually transmitted infections, and HIV transmission.</p>
<p>Adolescents with alcohol use problems often experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761811/">mental health problems</a>, including mood disorders, anxiety disorders, conduct disorders and suicidal behaviour. These can be both the consequence of and the cause of alcohol use.</p>
<p>Impulsivity and risk taking are hallmarks of adolescence. Alcohol use exacerbates impulsivity and impairs judgement, thus increasing risk-taking behaviour in adolescence and increasing the likelihood of adverse outcomes, including injury and death.</p>
<p>Crucially, alcohol has harmful effects on adolescent <a href="https://www.sciencedirect.com/science/article/pii/S0091305719306021?via%3Dihub">brain development</a>. It leads to changes in brain structure and function which affect cognitive functioning.</p>
<h2>Addressing the problem</h2>
<p>The South African government has attempted to address problems associated with underage drinking. In South Africa it is illegal for anyone under the age of 18 to purchase alcohol. The <a href="https://www.gov.za/documents/liquor-act#:%7E:text=to%20provide%20for%20essential%20national,provide%20for%20matters%20connected%20therewith.">National Liquor Act (2003)</a> also stipulates that no one may supply liquor to minors. </p>
<p>Government has proposed pieces of legislation aimed at banning the <a href="https://academic.oup.com/heapol/article/33/7/786/5042203">advertising of alcohol</a>, raising the legal drinking age, limiting <a href="https://www.gov.za/documents/liquor-amendment-bill-draft-30-sep-2016-0000">hours for alcohol sales</a>, and lowering the legal <a href="https://www.gov.za/sites/default/files/gcis_document/202006/b7-2020nationalroadtraffic.pdf">maximum alcohol limit for drivers</a>. </p>
<p>To date no legislation in these areas has been enacted by Parliament. Alcohol use among young people remains high, with resulting negative consequences. On 4 July 2022, in response to the Enyobeni tragedy, President Cyril Ramaphosa <a href="https://presidency.click.bulkmailapp.co.za/social/s_enc/Z11kyqMsg8xR_5f9DPy3LmFCZWL_c6DzaXk2XEncTKs">called</a> for a conversation on the problem of under-age drinking. This suggests there may be political will to follow through with the proposed legislative changes. </p>
<p>The president referred broadly to action needed in several areas: </p>
<ul>
<li><p>good parenting </p></li>
<li><p>strengthening families </p></li>
<li><p>addressing shortcomings in recreational facilities </p></li>
<li><p>better enforcement of liquor outlet regulations </p></li>
<li><p>greater community engagement and stopping people aiming to put profit before the lives of children. </p></li>
</ul>
<p>Progress on these proposed interventions would go a long way to reducing alcohol consumption by young people and the associated harms. </p>
<h2>Recommendations</h2>
<p>The president’s recommendations place the burden of care on families and communities. However, the government also has a responsibility to protect children from alcohol-related harm. </p>
<p>To have a more meaningful effect, we propose concrete action in the following areas: </p>
<ul>
<li><p>a ban of packaging that appeals to young people </p></li>
<li><p>an increase in excise taxes on products that appeal to young people, such as fruit-flavoured alcoholic drinks </p></li>
<li><p>a ban on free alcohol and other forms of heavy discounting of alcohol prices </p></li>
<li><p>a limit on young people’s exposure to alcohol marketing at points of sale, on billboards, at sporting events and in other media such as via the internet and social media </p></li>
<li><p>accrediting of school-based prevention programmes to improve the quality of such programmes </p></li>
<li><p>ensuring that there are appropriate and high-quality treatment programmes available for young people </p></li>
<li><p>increased inspections of liquor outlets to ensure compliance with licensing regulations</p></li>
<li><p>mandatory verification of age for people buying alcohol via home delivery </p></li>
<li><p>a graduated driver’s licensing system whereby drivers aged 18 to 21 years are not permitted to test positive for any alcohol when driving. </p></li>
</ul>
<p>Our recommendations are in line with the World Health Organization’s <a href="https://www.who.int/initiatives/SAFER">SAFER initiative</a> as well as the <a href="https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/alcohol/our-activities/towards-and-action-plan-on-alcohol">Global Alcohol Action Plan</a> which was unanimously adopted by member states – including South Africa – at the World Health Assembly in May 2022. </p>
<p><em>Jason Bantjes and Charles Parry are contributors to the latest issue of the <a href="http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/2022/Child%20Gauge%202021_FINAL_screen.pdf">South African Child Gauge</a>, which focuses on child and adolescent mental health, including the problems associated with underage drinking in South Africa and the need for public and government action to safeguard young people.</em></p><img src="https://counter.theconversation.com/content/186396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adolescent alcohol consumption is driven by several factors such as the availability of alcohol and social norms.Charles Parry, Director, Alcohol, Tobacco & Other Drug Research Unit, SAMRC, South African Medical Research CouncilJason Bantjes, Chief Specialist Scientist in Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722182022-02-02T18:52:15Z2022-02-02T18:52:15ZFish on acid? Microdosing zebrafish with LSD shows its potential benefits for humans<figure><img src="https://images.theconversation.com/files/443433/original/file-20220131-126279-j84hlf.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C2600%2C1650&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because of their social nature and the fact that they share 70 per cent of their DNA with humans, zebrafish make ideal test subjects.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/fish-on-acid-microdosing-zebrafish-with-lsd-shows-its-potential-benefits-for-humans" width="100%" height="400"></iframe>
<p>Microdosing — <a href="https://www.theguardian.com/society/2021/dec/02/people-microdosing-on-psychedelics-to-improve-wellbeing-during-pandemic">regularly ingesting small amounts of a psychedelic substance</a> — has gone mainstream.</p>
<p>Believed to increase productivity, spark creativity or improve open-mindedness, the microdosing of psychedelic drugs is gaining popularity with both academic researchers and those interested in experimenting.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/microdosers-of-lsd-and-magic-mushrooms-are-wiser-and-more-creative-101302">'Microdosers' of LSD and magic mushrooms are wiser and more creative</a>
</strong>
</em>
</p>
<hr>
<p>But microdosing may offer more beyond its mood-boosting abilities.</p>
<p>Using zebrafish and our new method for precise and repeated drug administration, my colleagues and I are studying LSD and terpenes (chemicals in plants responsible for their scent, among other things) in a series of projects exploring potential novel treatments for mental illness and alcohol use disorder.</p>
<p>Zebrafish might seem an odd choice in studying human health, but <a href="https://doi.org/10.1038/nature12111">they share 70 per cent of their genes with us</a> and are a popular nonhuman organism used by scientists to study biological processes. They are also incredibly social, making them <a href="https://dx.doi.org/10.1038/s12276-021-00571-5">well-suited for behavioural studies into psychiatric disorders</a> and <a href="https://doi.org/10.1038/nrd46277">drug discovery</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/animals-in-research-zebrafish-13804">Animals in research: zebrafish</a>
</strong>
</em>
</p>
<hr>
<p>However, past drug research using zebrafish has studied “chronic” administration — putting fish in a drug solution for weeks. Since humans require (at the very least) some sleep, this administration can’t accurately reflect human consumption patterns.</p>
<h2>Dose control</h2>
<p>To address this limitation, we developed a new method to dose multiple fish accurately and efficiently for exact exposure times. By placing an insert into the housing tank, we can move groups of fish from their housing tank into a dosing tank for a precise dosing period, more closely mimicking the way that a person might consume drugs or alcohol.</p>
<p>To verify that this new dosing procedure could have behavioural and neurochemical effects, we completed a series of projects using our new method to examine the effects of alcohol and nicotine.</p>
<p>First, we tested the zebrafish with a daily moderate dose or a weekly binge-level dose of ethanol for three weeks. We found a significant difference in <a href="https://doi.org/10.1371/journal.pone.0063319">location preference in the daily moderate group</a> compared to controls during a withdrawal period, which implies there were neurological changes. </p>
<p>Then we followed up with a study using <a href="https://doi.org/10.7717/peerj.6551">lower doses for shorter periods of time</a>. Here, we saw decreased boldness and increased anxiety-like behaviour during withdrawal from the highest dose (<a href="http://dx.doi.org/10.7717/peerj.2994">opposite to what is seen after an acute single-dose</a>). </p>
<p>Similarly, testing the model <a href="https://doi.org/10.1038/s41598-020-65382-6">using nicotine</a>, we found again that acute doses decreased anxiety-like behaviour while repeated dosing led to an increase of anxiety-like behaviour during withdrawal.</p>
<p>For humans, having an alcoholic drink or a cigarette <a href="https://doi.org/10.1176/ajp.147.6.685">can decrease anxiety, and the inverse is observed in withdrawal</a>. Our zebrafish model is consistent with this, which has given us confidence that we can test novel compounds with potential therapeutic effects in humans.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a short glass drink with alcohol next to an ashtray with a smoldering cigarette in it. in the background, out of focus, a man wearing a blue shirt and surgical mask" src="https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443573/original/file-20220131-142871-nfbzlc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Researchers have been finding that cigarette and alcohol consumption has increased during the pandemic. These substances can reduce anxiety, but withdrawal from them can increase it.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Potential therapies</h2>
<p>Terpenes are a large and diverse group of aromatic compounds. They are responsible for the smell, taste and pigmentation of plants. Many terpenes — like those found in tea, lemongrass, cannabis and citrus fruits — <a href="https://dx.doi.org/10.1007/978-3-030-31269-5_15">have medical benefits</a>.</p>
<p>We found that zebrafish acutely dosed with the terpene limonene (found in citrus fruit peels and cannabis) and myrcene (found in cannabis and hops), showed a significant reduction in anxiety-like behaviour. One observation that may be clinically significant is that — contrary to nicotine or alcohol — no negative effects were seen after repeated dosing for seven days, <a href="https://doi.org/10.1038/s41598-021-98768-1">suggesting minimal to no addictive potential</a>. </p>
<p><a href="https://doi.org/10.1038/s41598-021-98768-1">This study</a>, alongside <a href="https://doi.org/10.1078/094471102321621304">previous research</a>, suggests that the terpenes limonene and beta-myrcene possess sedative and anti-anxiety effects that have potential as valuable therapeutic compounds for the treatment of a variety of mental health conditions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="close-up of a hand holding tweezers handling small squares of cardboard that are microdose tabs" src="https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443561/original/file-20220131-141004-b3qulk.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">There is a growing interest in microdosing psychedelics to increase productivity and spark creativity.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Prairie psychedelic research</h2>
<p>Some of the most influential research into psychedelics <a href="https://www.thecanadianencyclopedia.ca/en/article/psychedelic-research-in-1950s-saskatchewan">began in Saskatchewan in the 1950s</a>. British-born psychiatrist Humphry Osmond <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381240/">used LSD and mescaline to treat alcoholism</a>, with single doses showing a 50 to 90 per cent recovery rate over two years.</p>
<p>However, while Osmond saw success in large single-dose treatments, the acute administrations required continuous monitoring of the patient over the seven- to 15-hour “trip” to prevent any <a href="https://dx.doi.org/10.1124/pr.115.011478">harm arising from impaired judgment</a>. From a therapeutic perspective, this would be very time-intensive for clinicians, and is not feasible. </p>
<p>This is where microdosing comes in. With the potential to be <a href="https://doi.org/10.1007/s00213-019-05417-7">easy and safe</a>, we believe this pattern of exposure to be more therapeutically relevant, as doses are small enough to be safely self-administered with the proper guidance of a clinician.</p>
<h2>Future knowledge</h2>
<p>In our first study, we repeatedly microdosed our zebrafish with LSD. Using behavioural neuroscience tests to quantify locomotion, boldness and anxiety-like behaviour, we observed no impact on behaviour after 10 days of repeated dosing. Like with terpenes, this may suggest a lack of withdrawal symptoms or addictive potential, which is encouraging for clinically viability for use in humans.</p>
<p>Our current study examines the effects of LSD microdosing on the symptoms of alcohol withdrawal, <a href="https://policyoptions.irpp.org/magazines/april-2021/covid-19-shows-us-why-canada-needs-a-federal-alcohol-act/">which is a growing issue in Canadian health care</a>.</p>
<p>In Canada, the negative effects of alcohol are widely felt. Fetal alcohol spectrum disorder remains the leading developmental disability in Canada, and alcohol harm is a top <a href="https://www.cihi.ca/sites/default/files/document/report-alcohol-hospitalizations-en-web.pdf">cause of injury and death</a>. It costs Canadians <a href="https://csuch.ca/publications/CSUCH-Canadian-Substance-Use-Costs-Harms-Infographic-2020-en.pdf">billions of dollars in lost productivity, and is a burden on the health-care and judicial systems</a>. Treatment and rehabilitation can be costly, time consuming and bogged down in lengthy wait times — if accessible at all.</p>
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Read more:
<a href="https://theconversation.com/fetal-alcohol-spectrum-disorder-amid-covid-19-fewer-services-potential-boost-in-rates-145593">Fetal alcohol spectrum disorder amid COVID-19: Fewer services, potential boost in rates</a>
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<p>Further research into other psychedelics, like psilocin (the psychoactive compound in psilocybin, or “magic mushrooms”), are also planned with the goal of providing scientific evidence to help determine whether these substances should be used in larger clinical trials in humans.</p>
<p>Psychedelics may provide assistance, but despite increasing evidence that LSD and psilocin <a href="https://doi.org/10.1016/j.pharmthera.2003.11.002">are non-addictive and low risk</a>, they remain highly restricted. Perhaps with more research and the continuing shift in public perception, we might yet again see LSD being used as a radical treatment for mental health and addiction.</p><img src="https://counter.theconversation.com/content/172218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trevor James Hamilton receives funding from the Natural Sciences and Engineering Research Council of Canada (NSERC). </span></em></p>Growing interest in psychedelics has spurred new research decades after hallucinogenics were tested in Saskatchewan in the 1950s. And an unassuming common fish is proving a useful test subject.Trevor James Hamilton, Associate Professor in Neuroscience (Department of Psychology), MacEwan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1622222021-06-10T12:36:52Z2021-06-10T12:36:52ZAlcohol companies make $17.5 billion a year off of underage drinking, while prevention efforts are starved for cash<figure><img src="https://images.theconversation.com/files/404928/original/file-20210607-10178-1b5bfg2.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4679%2C2354&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New research estimates that underage drinkers consume $2.2 billion of Anheuser-Busch InBev drinks – like Budweiser – per year.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/EarnsABInBev/177404906dfa4944b17cc3bf5a42442f/photo?Query=ab%20AND%20inbev&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=63&currentItemNo=0">AP Photo/Reed Saxon</a></span></figcaption></figure><figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405233/original/file-20210609-19-1gvoc6d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">CC–BY–ND.</span>
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</figure>
<p>Alcohol is still the <a href="https://www.cdc.gov/mmwr/volumes/69/su/su6901a5.htm">most commonly used</a> drug among high school students. According to the Centers for Disease Control and Prevention, every year approximately <a href="https://nccd.cdc.gov/DPH_ARDI/Default/Report.aspx?T=AAM&P=1A04A664-0244-42C1-91DE-316F3AF6B447&R=B885BD06-13DF-45CD-8DD8-AA6B178C4ECE&M=32B5FFE7-81D2-43C5-A892-9B9B3C4246C7&F=&D=">3,500 people under 21 die because of alcohol use</a>. </p>
<p>I have studied the relationship between alcohol marketing and youth drinking behavior for the past 20 years. In 2011, my colleagues and I performed what to our knowledge was the first and only survey of <a href="https://doi.org/10.1111/acer.12084">what specific brands of alcohol underage people drink</a>. We asked 1,032 young drinkers about 898 brands of alcohol to learn what the underage alcohol market looks like.</p>
<p>In a new paper published on June 9, 2021, my colleagues and I combined our survey data with the latest information available about alcohol consumption among adults to estimate the percent of all alcohol sold in the U.S. <a href="https://doi.org/10.15288/jsad.2021.82.368">that was consumed by young people</a>. Then, we were able to calculate how much money underage drinkers are spending and, importantly, <a href="https://doi.org/10.15288/jsad.2021.82.368">which companies are making this money</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two empty red plastic cups next to tipped over beer bottles." src="https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/404930/original/file-20210607-27-1lo02iv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Just three companies account for nearly half of all alcohol consumed by minors.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/photo-illustration-for-underage-drinking-with-empty-beer-news-photo/1315945612?adppopup=true">MediaNews Group/Reading Eagle via Getty Images</a></span>
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<h2>Who makes money from underage drinking?</h2>
<p>In 2016, the most recent year for which market research and government data were available, the total value of alcoholic beverage sales in the U.S. <a href="https://doi.org/10.15288/jsad.2021.82.368">was around US$237.1 billion</a>. Using our model of the youth market from 2011 and our database of alcohol prices, we were able to estimate the retail sales of youth consumption for 2011 and project it to 2016. In total, we estimate that youth under 21 accounted for <a href="https://doi.org/10.15288/jsad.2021.82.368">8.6% of the drinks consumed and 7.4% of the dollars spent</a>, since young people buy cheaper alcohol. This translates to $17.5 billion. While underage drinking has been <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics">steadily declining since 2002</a>, it is still a substantial source of income for these companies. </p>
<p>According to our <a href="https://doi.org/10.1111/acer.12084">2011 survey</a>, the 10 most popular alcohol brands among underage drinkers were Bud Light, Budweiser, Smirnoff Malt Beverages, Smirnoff Vodkas, Coors Light, Jack Daniel’s Bourbons, Corona Extra, Mike’s, Captain Morgan Rums and Absolut Vodkas.</p>
<p>Three companies own most of these drinks and accounted for nearly half – 44.7% – of the alcoholic drinks consumed by young people. Anheuser-Busch InBev accounted for 21.2% of of these drinks, from which they earned $2.2 billion. MillerCoors sold 11.1% of the booze, earning $1.1 billion. Spirits- and beer-maker Diageo also sold 11.1% of the beverages youth drank – and, since liquor tends to be more expensive per drink compared to beer, earned $2 billion from underage drinking.</p>
<h2>Revenues from underage drinking could be put to good use</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign on a fence saying 'Must be 21 years old to enter.'" src="https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/404929/original/file-20210607-80132-1mr4oht.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alcohol companies claim to be against underage drinking but contribute very little money to effective programs aimed at reducing the large market.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/drinking-age-royalty-free-image/172281583?adppopup=true">Kameleon007/iStock via Getty Images Plus</a></span>
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</figure>
<p>Brewing industry trade association the Beer Institute says that the “<a href="https://www.beerinstitute.org/wp-content/uploads/2018/12/BI_WhitePaper2018.pdf">U.S. beer industry has dedicated itself to preventing illegal underage drinking for more than three decades</a>.” They go on to say that companies do their part to make sure advertising is aimed at adults, educate parents and college students about underage drinking and encourage stores to not sell alcohol to minors.</p>
<p>However, <a href="https://dx.doi.org/10.1093%2Feurpub%2Fcky065">numerous studies</a> have found that alcohol companies’ actions to prevent alcohol-related harms are ineffective. Our research clearly demonstrates a conflict of interest: These companies are making literally billions of dollars from the very behavior they say they want to prevent. </p>
<p>In response to a request from Congress, in 2003, the National Research Council and Institute of Medicine issued a <a href="https://doi.org/10.17226/10729">major report on reducing underage drinking</a>. They recommended that all segments of the alcohol industry that profit from underage drinking place 0.5% of total company revenues in an independent nonprofit foundation dedicated to reducing and preventing underage drinking. In 2016, this would have amounted, for example, to $78 million from Anheuser-Busch InBev. This money could do a lot to support community groups trying to implement <a href="https://www.thecommunityguide.org/topic/excessive-alcohol-consumption?page=1">evidence-based strategies</a> such as reducing density of stores that sell alcohol, raising alcohol taxes and increasing enforcement around illegal sales to minors. </p>
<p>But no independent fund was ever created, and the alcohol companies themselves continue to control the money they contribute to preventing underage drinking, largely spending it on branded “corporate social responsibility” efforts that do more to <a href="https://dx.doi.org/10.1093%2Feurpub%2Fcky065">promote their products than prevent harmful drinking</a>. </p>
<p>Meanwhile, federal funding specifically dedicated to the prevention of underage drinking is minimal. The <a href="https://www.samhsa.gov/sites/default/files/samhsa-fy-2022-cj.pdf">most recent president’s budget</a> recommended a mere $10 million for grants to community coalitions working on underage drinking. On top of this, as a result of a significant alcohol tax cut passed in 2017 and <a href="https://www.thedrinksbusiness.com/2020/12/us-alcohol-producers-benefit-from-900bn-stimulus-package/">made permanent in 2020</a>, alcohol companies are contributing less to the federal budget than ever.</p>
<p>I believe that, because of their conflict of interest, alcohol companies cannot be trusted to spend prevention dollars effectively. The billions these companies make from underage drinking is money that the prevention field could really use. A system, independent of the industry, that would collect and allocate these unwanted revenues could be a better way to get it to local communities and help reduce and prevent underage drinking.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/162222/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David H. Jernigan receives funding from the National Institute on Alcohol Abuse and Alcoholism and the de Beaumont Foundation. He also serves as the Scientific Chair of the Global Alcohol Policy Alliance.</span></em></p>In the US, underage drinking accounts for a whopping US$17.5 billion worth of alcohol yearly. New research shows which companies take in most of this money and how little is spent on prevention.David H. Jernigan, Professor of Health Law, Policy & Management, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1498952020-11-19T14:07:18Z2020-11-19T14:07:18ZCollege-age kids and teens are drinking less alcohol – marijuana is a different story<figure><img src="https://images.theconversation.com/files/370200/original/file-20201118-21-vstcxe.jpg?ixlib=rb-1.1.0&rect=279%2C216%2C5144%2C3487&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young people's attitudes toward alcohol have changed over the years. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cheerful-friends-enjoying-during-lunch-break-royalty-free-image/1170998115">Klaus Vedfelt via Getty Images</a></span></figcaption></figure><p>Young adults aren’t drinking as much as they used to. In fact, more than a quarter don’t drink alcohol at all, recent surveys show.</p>
<p>It’s good news for health. But there is also a downside in the data: While alcohol use is falling among 18-to-22-year-olds, marijuana use is inching upward. The number of young adults using both alcohol and marijuana is also rising, heightening concerns about a future surge in substance abuse problems, <a href="http://doi.org/10.1001/jamapediatrics.2020.3352">new research shows</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=0nERiGAAAAAJ&hl=en">professor of psychology</a> at Texas State University who has been studying young adult and adolescent substance use for over 15 years. A key interest of mine is how substance use changes over adolescence and young adulthood. It is a period of profound change: A 13-year-old is very different from a 25-year-old in nearly every way.</p>
<p>With colleagues at the University of Michigan, the University of Central Florida and Iowa State University, I have been investigating trends in alcohol and marijuana use in young adults to better understand how use changes with age. The latest numbers offer both hope and concern.</p>
<h2>Gen Z is breaking stereotypes</h2>
<p>There are reasons for the stereotype of hard-drinking, substance-using young adults, as photos and videos from bars and college parties will attest. But surveys and <a href="http://doi.org/10.1001/jamapediatrics.2020.3352">our analysis</a> suggest that binge drinking isn’t as common as people may believe it is. </p>
<p>Using data from the <a href="https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf">annual National Survey on Drug Use and Health</a>, we found that in 2018 nearly 30% of college-age adults, ages 18-22, had not had a single alcoholic drink during the previous year, compared with fewer than a quarter in 2002. Over 60% had not used marijuana at all.</p>
<p>Among 18-to-25-year-olds, the number who reported binge drinking in the previous year fell from 39% in 2015 to 34% in 2019. That may be influenced at least in part by beliefs that are forming in high school. Another survey shows that nearly three-quarters of high school seniors think their <a href="https://www.drugabuse.gov/drug-topics/trends-statistics/monitoring-future">friends would disapprove</a> of weekend binge drinking, up from just over half in the early 1980s.</p>
<p>Adolescents – typically 12 to 17 years of age – were more likely to avoid both alcohol and marijuana than they were two decades ago, part of a larger trend in declining substance use and risky behavior among adolescents seen in a variety of national surveys and data sources. In 2019, nearly 80% of adolescents had not used alcohol at all in the previous year, compared with 65% in 2002, and 87% had not used marijuana. </p>
<figure class="align-center ">
<img alt="Trend lines for alcohol and marijuana use by age" src="https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/369743/original/file-20201117-23-1l80f1t.png?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"></span>
<span class="attribution"><a class="source" href="https://datawrapper.dwcdn.net/TKd5o/4/">McCabe et al.; National Survey on Drug Use and Health</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Using both marijuana and alcohol</h2>
<p>The bad news is that the number of college-age young adults saying they used marijuana at least once in the previous year has increased, from 33% to 37%. </p>
<p>The vast majority who said they used marijuana also used alcohol. We found that the increase in young adults using both <a href="http://doi.org/10.1001/jamapediatrics.2020.3352">was a result</a> of young adults who used alcohol taking up marijuana, too.</p>
<p>This increase in using both alcohol and marijuana is an important warning sign, because young adults in that group also had much higher rates of other illicit drug use, like cocaine, and prescription drug misuse, involving medications like opioids or benzodiazepines.</p>
<p>That may signal that a greater number will need substance use treatment in the coming years.</p>
<figure class="align-center ">
<img alt="Chart of alcohol and marijuana use with other illicit drugs" src="https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/369742/original/file-20201117-17-4kvf8x.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://datawrapper.dwcdn.net/ud8id/5/">McCabe et al, 2020</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Why the changes?</h2>
<p>One theory for the shifting trends in alcohol and marijuana use is that adolescent substance use is now starting at later ages. </p>
<p>The data support this: The numbers of adolescents starting alcohol use has declined somewhat, while more college-age adults are first-time alcohol and marijuana users. Why that shift is occurring is less clear, but one theory is that adolescents have been engaging in more virtual contact than face-to-face contact in recent years and they rarely use substances when they’re alone.</p>
<p>Changing regulations likely also play a role. Marijuana is now legal for medical or recreational use in an increasing <a href="https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx">number of states</a>.</p>
<p>Attitudes toward alcohol and marijuana have also changed over the years, particularly for marijuana.</p>
<p>The <a href="https://www.drugabuse.gov/drug-topics/trends-statistics/monitoring-future">Monitoring the Future</a> study, which has tracked substance use in adolescents and young adults since 1975, indicates both a sharp decline in disapproval of marijuana among middle and high school students and a decline in how harmful they perceive marijuana to be. In fact, more young people in that age group now see more harm from regular alcohol use than disapprove of marijuana.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>How the pandemic will change young people’s habits with alcohol and marijuana isn’t yet clear. One survey conducted this spring when many restaurants and bars were closed found that <a href="http://doi.org/10.1001/jamanetworkopen.2020.22942">adults over 30 were drinking alcohol 14% more often</a>. However, when researchers in Australia homed in on younger adults in Gen Z, they found a different story: Older age groups may be drinking more, but with bars and restaurants closed, 44% of the <a href="https://www.arts.unsw.edu.au/sprc/news/under-influence-how-covid-has-affected-our-drinking">college-age crowd reported drinking less</a>.</p><img src="https://counter.theconversation.com/content/149895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Ty Schepis receives funding from the National Institute on Drug Abuse, an institute of the National Institutes of Health. </span></em></p>Gen Z is breaking stereotypes, but there are still some worrying trends when it comes to substance abuse.Ty Schepis, Professor of Psychology, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1404542020-06-17T20:06:03Z2020-06-17T20:06:03ZGetting back on the beers after lockdown? Here’s what you should know<p>If you’re feeling excited about being out of lockdown, you’re not alone. Social media is buzzing with plans of big nights out to celebrate the relaxation of coronavirus restrictions in Australia and New Zealand.</p>
<p>But before you go on that big bender, here are some things to keep in mind so you don’t overdo it.</p>
<h2>How has lockdown changed our drinking habits?</h2>
<p>Several surveys have highlighted the disruption coronavirus has made to our drinking habits. First, there was a <a href="https://10daily.com.au/news/a200322efyol/panic-buyers-turn-to-stockpiling-grog-during-coronavirus-pandemic-20200322">run on alcohol</a>, with people stockpiling their favourite drinks. The Commonwealth Bank of Australia reported <a href="https://www.commbank.com.au/guidance/business/an-early-look-at-how-the-coronavirus-is-affecting-household-spen-202003.html">spending on alcohol</a> was up more than 20% in the initial few weeks of lockdown.</p>
<p>Many <a href="https://www.theguardian.com/lifeandstyle/2020/apr/07/drinking-in-coronavirus-isolation-experts-warn-australians-to-monitor-their-intake">experts were worried</a> drinking would drastically increase, along with many of its harmful consequences. These include greater risk of mental health problems, family violence, and alcohol dependence.</p>
<p>Data from several sources confirmed drinking habits changed during lockdown. A survey by alcohol advocacy group <a href="https://fare.org.au/">Foundation for Alcohol Research and Education</a> (FARE) found people who had been stockpiling alcohol weren’t just keeping it for a rainy day - <a href="https://fare.org.au/many-australians-using-more-alcohol-and-worried-about-household-drinking/">70% reported</a> drinking more and 30% were worried about their own or someone else’s drinking.</p>
<p>The Australian Bureau of Statistics (ABS) found, overall, 14% of Australians reported <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/4940.0Main%20Features629%20Apr%20-%204%20May%202020?opendocument&tabname=Summary&prodno=4940.0&issue=29%20Apr%20-%204%20May%202020&num=&view=">increasing their alcohol consumption</a>, while 10% reported a reduction.</p>
<p>The Australian National University found, in particular, <a href="https://csrm.cass.anu.edu.au/research/publications/alcohol-consumption-during-covid-19-period-may-2020">women have been drinking significantly more</a> than pre-lockdown levels. Having child-caring responsibilities was a big predictor of increased alcohol consumption. </p>
<p>The ABS data also found the major increase in drinking was <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/4940.0Main%20Features629%20Apr%20-%204%20May%202020?opendocument&tabname=Summary&prodno=4940.0&issue=29%20Apr%20-%204%20May%202020&num=&view=">among women</a>. This exacerbates a <a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">worrying trend</a> over the past few years of women increasing their drinking.</p>
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<strong>
Read more:
<a href="https://theconversation.com/women-are-drinking-more-during-the-pandemic-and-its-probably-got-a-lot-to-do-with-their-mental-health-139295">Women are drinking more during the pandemic, and it's probably got a lot to do with their mental health</a>
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<p><a href="https://hellosundaymorning.org/2020/04/22/are-we-drinking-more-during-isolation/">Hello Sunday Morning</a>, an organisation that helps people change their relationship with alcohol, also reported a significant increase in people accessing their online services.</p>
<h2>Your alcohol tolerance may have changed</h2>
<p>Changes in the amount you drink can affect your <a href="https://pubs.niaaa.nih.gov/publications/aa28.htm">alcohol tolerance</a>. How intoxicated you feel is related to your tolerance, whereas your blood alcohol concentration is more related to how much you have drunk over a certain time period. </p>
<p>This means if you’ve been drinking more during lockdown, your tolerance has probably increased. You would need to consume more alcohol to feel the effects you used to get from fewer drinks. If you feel less of the effects of alcohol, you might drink more without realising it.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-taking-a-break-from-alcohol-heres-how-to-cut-back-or-quit-130952">Thinking about taking a break from alcohol? Here's how to cut back or quit</a>
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<p>While you might not feel as drunk, your brain function is still <a href="https://pubmed.ncbi.nlm.nih.gov/20695689/">affected</a> and you can still be over the legal limit for driving. Take care to monitor the number of drinks you are consuming and plan how you’ll get home without driving.</p>
<p>Higher tolerance to alcohol means you are also at increased risk of <a href="https://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578">alcohol-related harm</a>. Higher tolerance is associated with <a href="https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders">alcohol-use disorders</a> and is one of the first signs of dependence.</p>
<p>On the other hand, if you have been drinking less, your tolerance may have decreased so a smaller amount of alcohol will affect you more than normal. This means if you drink the same amount as usual you might get drunk more quickly.</p>
<p>Take it slowly or you might end up a lot drunker than you planned. Monitor how you feel, and if your tolerance has decreased enjoy the extra cash you’re saving on drinks!</p>
<h2>How to avoid drinking too much</h2>
<p>To help avoid unintentionally drinking more than you planned, keep in mind these simple tips:</p>
<ul>
<li><p><strong>set limits and count your drinks.</strong> Before you start drinking, decide how much you want to drink and stick to it. The <a href="https://www.nhmrc.gov.au/health-advice/alcohol">draft Australian alcohol guidelines</a> recommend no more than ten <a href="https://www.health.gov.au/health-topics/alcohol/about-alcohol/standard-drinks-guide#what-are-standard-drinks">standard drinks</a> a week, and no more than four in a day for healthy adults. If you have an existing health problem, alcohol affects you more so you should drink even less. If you are under 18 or pregnant, you shouldn’t drink at all</p></li>
<li><p><strong>alternate your drinks with water and sip slowly.</strong> Have at least one glass of water or a no sugar, non-alcoholic drink for every alcoholic drink. It will help slow you down and can also reduce the likelihood of a <a href="https://theconversation.com/what-causes-hangovers-blackouts-and-hangxiety-everything-you-need-to-know-about-alcohol-these-holidays-127995">nasty hangover</a> the next day. Avoid shots or buying rounds, so you can comfortably sit on your drinks and sip them slowly</p></li>
<li><p><strong>eat before and during drinking.</strong> This will help slow your drinking down and also slows the <a href="https://www.youtube.com/watch?time_continue=15&v=QHYlRc6-Gdw&feature=emb_logo">absorption of alcohol</a>. You’ll be better able to monitor how much you are drinking, so you are less likely to overindulge.</p></li>
</ul>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-hangovers-blackouts-and-hangxiety-everything-you-need-to-know-about-alcohol-these-holidays-127995">What causes hangovers, blackouts and 'hangxiety'? Everything you need to know about alcohol these holidays</a>
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<h2>How to have a good time while distancing</h2>
<p>While you might be itching for things to get back to normal, we are still distancing while out in public. Make sure you are aware of your <a href="https://www.healthdirect.gov.au/coronavirus-covid-19-information-by-state-and-territory">state or territory’s restrictions</a>.</p>
<p>Remember your favourite pubs and restaurants have to follow strict rules, so respect the staff and the new practices they have put in place to keep everyone safe. Ask before merging tables, respect capacity limits, sign in with your name and phone number when requested, and use hand sanitiser if offered on arrival.</p>
<p>When out drinking, don’t share drinks and continue to follow COVID-related <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/good-hygiene-for-coronavirus-covid-19">rules and guidelines</a> such as:</p>
<ul>
<li><p>keep <strong>1.5 metres away</strong> from each other</p></li>
<li><p><strong>don’t touch</strong> your eyes, nose or mouth</p></li>
<li><p>maintain good hygiene practices such as <strong>hand-washing</strong></p></li>
<li><p>download the <strong>COVIDSafe app</strong> and have it open and running while out.</p></li>
</ul>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covidsafe-tracking-app-reviewed-the-government-delivers-on-data-security-but-other-issues-remain-137249">COVIDSafe tracking app reviewed: the government delivers on data security, but other issues remain</a>
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<h2>Where to get help</h2>
<p>If you want to lower your tolerance, you can <a href="https://theconversation.com/thinking-about-taking-a-break-from-alcohol-heres-how-to-cut-back-or-quit-130952">take a break</a> from alcohol and “reset” your system.</p>
<p>To check your consumption, try the <a href="https://auditscreen.org/">AUDIT screening tool</a> online.</p>
<p>If you’d like to talk to someone about your drinking, call the National Alcohol and Other Drug Hotline on 1800 250 015. It’s a free call from anywhere in Australia. You can chat online with a counsellor at <a href="https://www.counsellingonline.org.au/">CounsellingOnline</a>.</p>
<p>You can also talk to your GP. Many clinics are now conducting appointments via telehealth.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-has-boosted-telehealth-care-in-mental-health-so-lets-keep-it-up-137381">Coronavirus has boosted telehealth care in mental health, so let's keep it up</a>
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<p><em>This article is supported by the <a href="https://theconversation.com/au/partners/judith-neilson-institute">Judith Neilson Institute for Journalism and Ideas</a>.</em></p><img src="https://counter.theconversation.com/content/140454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brigid Clancy works as a contractor to a private alcohol and other drug consultancy.</span></em></p><p class="fine-print"><em><span>Nicole Lee 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 drug prevention and treatment. She is a member of board of directors of Hello Sunday Morning.</span></em></p>Be careful when returning to the pub. Your alcohol tolerance might’ve changed during lockdown, meaning you could do greater harm to your body.Brigid Clancy, PhD Candidate (Psychiatry) & Research Assistant, University of NewcastleNicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1355322020-04-08T12:11:17Z2020-04-08T12:11:17ZAmerica is drinking its way through the coronavirus crisis – that means more health woes ahead<figure><img src="https://images.theconversation.com/files/325917/original/file-20200406-104477-j01c02.jpg?ixlib=rb-1.1.0&rect=19%2C25%2C4215%2C2795&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shopping for wine in Seattle, where many liquor stores are considered "essential businesses."</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Whats-Essential/3b87dd1d345748bbbcc76d1ff72ae260/27/0">AP Photo/Elaine Thompson</a></span></figcaption></figure><p>In the midst of the COVID-19 epidemic, it has become easier to buy alcohol than toilet paper or eggs.</p>
<p>Across the U.S., governors are terming <a href="https://thehill.com/business-a-lobbying/business-a-lobbying/490514-coronavirus-brings-quick-changes-to-state-alcohol">alcohol sales an essential business</a> and loosening restrictions to <a href="https://www.usnews.com/news/best-states/articles/2020-03-19/more-states-offer-alcohol-delivery-and-takeout-amid-coronavirus">permit home delivery</a> and <a href="https://www.sfchronicle.com/wine/article/California-you-can-now-get-cocktails-delivered-15146289.php">carryout cocktails</a>, throwing an economic lifeline to one group of small businesses.</p>
<p>Are alcohol sales actually essential? According to the federal government, <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics">just over half of Americans age 18 and above (55.3%) drank alcohol in the past 30 days</a>; just over a quarter binged – more than four drinks on an occasion for women, or five for men – and 1 in 17 (5.8%) had an alcohol use disorder, ranging from mild to severe. </p>
<p>For those in this latter group who are actually dependent on it, alcohol may indeed be essential.</p>
<p>But evidence thus far in the epidemic is that people in general are buying more alcohol, and in larger quantities. As <a href="https://www.bu.edu/sph/profile/david-jernigan/">someone who has spent 30 years studying the link between alcohol policy and public health</a>, I know that this is likely to result in a spike in alcohol use disorders for years to come.</p>
<h2>Booze up</h2>
<p>According to <a href="https://www.eater.com/2020/3/27/21196290/liquour-grocery-store-alcohol-sales-increase-coronavirus-impact-covid-19">Nielsen figures</a>, for the week ending March 14, off-premise outlets such as liquor and grocery stores saw sales of wine up 27.6%, spirits by 26.4% and beer, cider and malt beverages by 14% compared to the same week a year earlier. Sales of 3-liter boxes of wine rose by 53%, and 24-packs of beer increased by 24%. Online alcohol sales for that week were also up, 42% year-on-year.</p>
<p><iframe id="CFwkA" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/CFwkA/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Some of this increase is undoubtedly stockpiling, especially given that in many locations bar and restaurants are closed. But we also know from prior experience and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953615001082?via%3Dihub">studies that periods of economic and psychological stress like this have two effects on alcohol use</a>. People have less money to spend on alcohol, which drives their spending down; at the same time, they are likely to drink more to alleviate the stress they are feeling. In short, they are buying larger quantities of cheaper alcohol.</p>
<p>This increase in drinking will have both a short- and a long-term impact on health and safety. In the short term, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319482/">alcohol abuse suppresses multiple aspects of the body’s immune system response</a>, with particular effects on the lungs’ ability to fight off infections like COVID-19.</p>
<p>The rise in off-premise sales of alcohol and home consumption will also likely affect interpersonal violence. Adding alcohol to a possibly violent situation is like pouring gasoline on a lit fire. Off-premise sales of alcohol are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214776/">more likely to be associated with violent crime than drinking in a bar or restaurant</a>, as the drinking takes place without the presence of servers and other patrons. Multiple cities are reporting <a href="https://www.baltimoresun.com/news/crime/bs-md-ci-cr-baltimore-crime-coronavirus-20200404-4yjfurpd4jcfvogxssaut232ty-story.html;%20DJ%20-%20better%20link%20is%20https://www.bloomberg.com/news/articles/2020-03-30/stuck-at-home-americans-get-robbed-less-often-but-fight-more">decreases in property crimes in the wake of the pandemic</a>, but <a href="https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html">a rise in domestic violence</a>. Child abuse cases may also be on the rise – while national data are not available, a Fort Worth hospital that usually sees eight such cases in a month <a href="https://www.nbcdfw.com/news/local/fort-worth-hospital-sees-spike-in-severe-child-abuse-cases-over-last-week/2336014/;DJ:This%20was%20the%20link%20I%20provided%20-%20%20https://www.nbcnews.com/news/us-news/police-see-rise-domestic-violence-calls-amid-coronavirus-lockdown-n1176151">saw six in a week</a>.</p>
<h2>Binge drinking</h2>
<p>As for long-term effects, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720767/">study of the impact of the SARS outbreak on Beijing hospital employees in 2003</a> found greater likelihood of alcohol abuse or dependence symptoms three years later associated with quarantine or working in high-risk settings such as wards dedicated to treating patients with the respiratory illness. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700547/">Greater exposure to the 9/11 terrorist attack on the World Trade Center</a> was associated with more binge drinking after a year, and higher odds of alcohol dependence one and two years later. In the wake of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782914/">Hurricane Katrina, alcohol consumption rose</a>. After Hurricane Rita, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761882/">adolescent alcohol use increased in Louisiana</a>. What this suggests is that during the coronavirus crisis, people are putting in place patterns of heavier drinking that will show up in future higher rates of alcohol use disorders.</p>
<p>As governors declare alcohol sales essential, cities can still use policy levers to flatten this curve of problems from alcohol use. Prior to the coronavirus outbreak, <a href="http://cityhealthdata.org/">CityHealth</a>, a project of the de Beaumont Foundation and Kaiser Permanente <a href="http://cityhealthdata.org/policy/40-cities-alcohol-outlet-density">rated the nation’s 40 largest cities</a> on whether they have claimed jurisdiction over alcohol sales within their borders. </p>
<p>Eight can regulate alcohol outlets, including limiting hours and days of sale, establishing maximum purchase amounts, and banning price discounting, which is known to increase alcohol consumption. If necessary, they can also shut down premises.</p>
<p>Another eight have elements of local control over alcohol sales, but lack jurisdiction over some portion of new or existing outlets.</p>
<p>The remaining 24 cities lack control, because they are preempted from it by state laws that prohibit local action, or because they have not expressly taken such authority in their city codes. Yet even in these cities, civic and public health leaders could use emergency powers to limit or shut down alcohol sales in their jurisdictions. </p>
<h2>Measures and optics</h2>
<p>A <a href="https://www.thecommunityguide.org/sites/default/files/publications/Alcohol-AJPM-evrev-outlet-density.pdf">large body of research</a> has found that the number of stores selling alcohol in an area, and how they serve and sell it matters for public health. The Task Force on Community Preventive Services concluded that limiting both <a href="https://www.thecommunityguide.org/sites/default/files/publications/Alcohol-AJPM-evrev-outlet-density.pdf">the density of outlets</a> and <a href="https://www.thecommunityguide.org/sites/default/files/publications/Alcohol-AJPM-evrev-hoursofsale.pdf">the hours and days they may sell</a> are effective measures for reducing alcohol problems.</p>
<p>There are many <a href="https://www.cnn.com/2020/03/06/business/coronavirus-global-panic-buying-toilet-paper/index.html">anecdotal reports of stores limiting</a> how many rolls of toilet paper consumers may purchase, yet people are walking out with cartloads of alcoholic beverages. Jurisdictions at every level, including cities, need to be aware of the likely effects of increased alcohol abuse in times like this, and use the policy levers at their disposal to mitigate these effects. Alcohol may be essential for some, but too much of it is dangerous for many, both now and into the future.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/135532/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David H. Jernigan receives funding from the de Beaumont Foundation and Kaiser Permanente. </span></em></p>Sales of alcohol have reported jumped by around a quarter as people bulk buy wine, beers and spirits. That could lead to a range of short-term and long-term problems.David H. Jernigan, Professor of Health Law, Policy & Management, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1346692020-03-27T05:41:58Z2020-03-27T05:41:58ZCoronavirus: it’s tempting to drink your worries away but there are healthier ways to manage stress and keep your drinking in check<figure><img src="https://images.theconversation.com/files/323487/original/file-20200327-146678-gbptb5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-sitting-on-couch-eating-pizza-554961352">Shutterstock</a></span></figcaption></figure><p>Bottle shops remain on the <a href="https://au.news.yahoo.com/coronavirus-what-is-still-open-in-australia-210641895.html?soc_src=social-sh&soc_trk=ma">list of essential services</a> allowed to stay open and Australians are <a href="https://10daily.com.au/news/a200322efyol/panic-buyers-turn-to-stockpiling-grog-during-coronavirus-pandemic-20200322">stocking up on alcohol</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1241906450181419008"}"></div></p>
<p>In these difficult times, it’s not surprising some people are looking to alcohol for a little stress reduction. But there are healthier ways of coping with the challenges we currently face.</p>
<h2>Why do we drink more in a crisis?</h2>
<p>People who feel stressed tend to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25771482?fbclid=IwAR3EUd9Pum2f9UmVCOsAPcG7OKhJnJZEdoZfVWrThX9SP8ay0c2uGvr0RJc">drink more</a> than people who are less stressed. In fact, we often see increases in people’s alcohol consumption after <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000143">catastrophes</a> and <a href="https://doi.org/10.1046/j.1360-0443.2000.9545295.x">natural disasters</a>.</p>
<p>Although alcohol initially helps us relax, after drinking, you can feel even more anxious. Alcohol releases <a href="https://theconversation.com/what-causes-hangovers-blackouts-and-hangxiety-everything-you-need-to-know-about-alcohol-these-holidays-127995">chemicals</a> in the brain that block anxiety. But our brain likes to be in balance. So after drinking, it reduces the amount of these chemicals to try to get back into pre-drinking balance, increasing feelings of anxiety.</p>
<p>People may also be drinking more alcohol to <a href="https://www.sciencedirect.com/science/article/pii/S2352853216300116">relieve the boredom</a> that may come with staying at home without much to do.</p>
<h2>What happens when we drink more?</h2>
<p><strong>Alcohol affects your ability to fight disease</strong></p>
<p>Alcohol impacts the immune system, increasing the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590612/">risk of illness and infections</a>. </p>
<p>Although the coronavirus is too new for us to know its exact interaction with alcohol, we know from <a href="https://doi.org/10.1037/0033-2909.122.1.56">other virus outbreaks</a> drinking affects how your immune system works, making us more susceptible to virus infection.</p>
<p>So, if you have the coronavirus, or are at risk of contracting it, you should limit your alcohol intake to give your immune system the best chance of fighting it off. The same applies if you have influenza or the common cold this winter.</p>
<p><strong>Alcohol affects your mood</strong></p>
<p>Drinking can <a href="https://theconversation.com/coronavirus-is-stressful-here-are-some-ways-to-cope-with-the-anxiety-133146">affect your mood</a>, making you prone to symptoms of depression and anxiety. </p>
<p>This is because alcohol has a depressant effect on your central nervous system. But when you stop drinking and the level of alcohol in your blood returns to zero, your nervous system becomes overactive. That can leave you <a href="https://www.beyondblue.org.au/personal-best/pillar/wellbeing/anxiety-after-drinking-and-what-you-can-do-about-it">feeling agitated</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-is-stressful-here-are-some-ways-to-cope-with-the-anxiety-133146">Coronavirus is stressful. Here are some ways to cope with the anxiety</a>
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</em>
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<p><strong>Alcohol affects your sleep</strong></p>
<p>Alcohol can disrupt <a href="https://theconversation.com/cant-sleep-and-feeling-anxious-about-coronavirus-youre-not-alone-134407">sleep</a>. You may fall asleep more quickly from the sedating effects of alcohol, but as your body processes alcohol, the sedative effects wear off. </p>
<p>You might wake up through the night and find it hard to fall back to sleep (not to mention the potential for snoring or extra nocturnal bathroom trips).</p>
<p><a href="https://theconversation.com/what-causes-hangovers-blackouts-and-hangxiety-everything-you-need-to-know-about-alcohol-these-holidays-127995">The next day</a>, you can be left feeling increasingly anxious, which can kickstart the process all over again.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-sleep-and-feeling-anxious-about-coronavirus-youre-not-alone-134407">Can't sleep and feeling anxious about coronavirus? You're not alone</a>
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</em>
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<p><strong>Alcohol affects your thoughts and feelings</strong></p>
<p>Alcohol reduces our capacity to monitor and regulate our <a href="https://pubmed.ncbi.nlm.nih.gov/22589026/">thoughts and feelings</a>.</p>
<p>Once we start drinking, it’s hard to know when we’re relaxed enough. After one or two drinks, it’s easy to think “another won’t hurt”, “I deserve it”, or “I’ve had a huge day managing the kids and working from home, so why not?”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323496/original/file-20200327-146666-yrif5v.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">It’s easy to think, ‘another won’t hurt’ when we’ve already had a drink or two.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-sitting-on-sofa-holding-tv-402611296">Shutterstock</a></span>
</figcaption>
</figure>
<p>But by increasing alcohol consumption over time, eventually it takes more alcohol to get to the same point of relaxation. Developing this kind of tolerance to alcohol can lead to dependence.</p>
<p><strong>Alcohol ties up the health system</strong></p>
<p>Alcohol related problems also take up a lot of health resources, including <a href="https://www2.health.vic.gov.au/about/publications/annualreports/Trends-in-Alcohol-and-Drug-Related-Ambulance-Attendances-in-Melbourne-2011-12">ambulances</a> and <a href="https://www1.racgp.org.au/newsgp/clinical/up-to-a-quarter-of-ed-presentations-are-alcohol-re">emergency departments</a>. People have more <a href="https://www.healthdirect.gov.au/alcohol-injuries">accidents</a> when they are drinking. And drinking can increase the risk of <a href="https://theconversation.com/alcohols-link-to-domestic-violence-is-in-focus-now-what-37696">domestic and family violence</a>.</p>
<p>So an increase in drinking risks unnecessarily tying up emergency services and hospitals, which are needed to respond to the coronavirus.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alcohol-leads-to-more-violence-than-other-drugs-but-youd-never-know-from-the-headlines-72281">Alcohol leads to more violence than other drugs, but you'd never know from the headlines</a>
</strong>
</em>
</p>
<hr>
<h2>How to manage your alcohol consumption</h2>
<p>Don’t stock up on alcohol. The more you have in the house, the more likely you are to drink. Increased access to alcohol also increases the risk of <a href="https://doi.org/10.1111/j.1360-0443.2007.01941.x">young people drinking</a>. </p>
<p>Monitor your drinking. If you are getting on board with the new <a href="https://www.forbes.com/sites/abrambrown/2020/03/15/the-coronavirus-has-brought-the-dawn-of-the-virtual-happy-hour/">virtual happy hour</a> trend, the same rules apply if you were at your favourite bar.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cap-your-alcohol-at-10-drinks-a-week-new-draft-guidelines-128856">Cap your alcohol at 10 drinks a week: new draft guidelines</a>
</strong>
</em>
</p>
<hr>
<p>Try to stay within the draft <a href="https://theconversation.com/cap-your-alcohol-at-10-drinks-a-week-new-draft-guidelines-128856">Australian guidelines</a> of no more than four <a href="https://www.health.gov.au/health-topics/alcohol/about-alcohol/standard-drinks-guide">standard drinks</a> in any one day and no more than ten a week. </p>
<p>Monitor your thinking. It’s easy to think “What does it matter if I have an extra one or two?”. Any changes to your drinking habits now can become a pattern in the future.</p>
<h2>How to manage stress without alcohol</h2>
<p>If you are feeling anxious, stressed, down or bored, you’re not alone. But there are other healthier ways to manage those feelings.</p>
<p>If you catch yourself worrying, try to remind yourself this is a temporary situation. Do some mindfulness meditation or slow your breathing, distract yourself with something <a href="https://www.rte.ie/brainstorm/2019/0710/1061221-turn-it-up-how-listening-to-music-reduces-stress/">enjoyable</a>, or practise <a href="https://youtu.be/gXDMoiEkyuQ">gratitude</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-stay-fit-and-active-at-home-during-the-coronavirus-self-isolation-134044">How to stay fit and active at home during the coronavirus self-isolation</a>
</strong>
</em>
</p>
<hr>
<p>Get as much exercise as you can. Exercise <a href="https://www.healthdirect.gov.au/exercise-and-mental-health">releases brain chemicals</a> that make you feel good. Even if you can’t get into your normal exercise routine, go outside for a walk or run. Walk to your local shops to pick up supplies instead of driving. </p>
<p>Maintain a good diet. We know <a href="https://youtu.be/xyQY8a-ng6g">good nutrition</a> is important to maintain <a href="https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626">good mental health</a>.</p>
<p>Try to get as much <a href="https://www.helpguide.org/articles/sleep/getting-better-sleep.htm">sleep</a> as you can. Worry can disrupt sleep and lack of sleep can <a href="https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health">worsen mental health</a>. </p>
<p>Build in pleasant activities to your day. Even if you can’t do the usual activities that bring a smile to your face, think about some new things you might enjoy and make sure you do one of those things every day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-tiny-moments-of-pleasure-really-can-help-us-through-this-stressful-time-134043">Coronavirus: tiny moments of pleasure really can help us through this stressful time</a>
</strong>
</em>
</p>
<hr>
<p>Remember, change doesn’t have to be negative. Novelty activates the dopamine system, our pleasure centre, so it’s a great time to <a href="https://buffer.com/resources/novelty-and-the-brain-how-to-learn-more-and-improve-your-memory">try something new</a>.</p>
<p>So enjoy a drink or two, but try not to go overboard and monitor your stress levels to give you the best chance to stay healthy.</p>
<hr>
<p><em>If you are trying to manage your drinking, <a href="https://www.hellosundaymorning.org">Hello Sunday Morning</a> offers a <a href="https://www.hellosundaymorning.org/daybreak/">free online community</a> of more than 100,000 like-minded people. You can connect and chat with others actively managing their alcohol consumption.</em> </p>
<p><em>If you’d like to talk to someone about your drinking call the <a href="https://www.health.gov.au/contacts/national-alcohol-and-other-drug-hotline-contact">National Alcohol and Other Drug Hotline</a> on 1800 250 015. It’s a free call from anywhere in Australia. Or talk to your GP.</em></p><img src="https://counter.theconversation.com/content/134669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee 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 drug prevention and treatment. She is a member of board of directors of Hello Sunday Morning.</span></em></p><p class="fine-print"><em><span>Genevieve Dingle is an Associate Professor in clinical psychology at the University of QLD. She receives funding from the Australian Research Council for a project about loneliness. She is the QLD representative on the Australian Professional Society for Alcohol and other Drugs (APSAD) council.</span></em></p><p class="fine-print"><em><span>Sonja Pohlman is a Lecturer in the School of Psychology at the University of Newcastle. </span></em></p>Stress and boredom might see us drinking more alcohol at home in the coming weeks and months. But there are alternatives.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityGenevieve Dingle, Associate Professor in Clinical Psychology, The University of QueenslandSonja Pohlman, Clinical Psychologist and Lecturer, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298542020-01-14T13:48:20Z2020-01-14T13:48:20ZHow Prohibition changed the way Americans drink, 100 years ago<figure><img src="https://images.theconversation.com/files/309806/original/file-20200113-103971-1ankvjp.jpg?ixlib=rb-1.1.0&rect=49%2C98%2C2946%2C2236&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prohibition did little to ease Americans' love of liquor.</span> <span class="attribution"><span class="source">AP Photo</span></span></figcaption></figure><p>On Jan. 17, 1920, one hundred years ago, <a href="https://timesmachine.nytimes.com/timesmachine/1920/01/16/106359667.html?pageNumber=1">America officially went dry</a>. </p>
<p><a href="https://www.theguardian.com/theguardian/from-the-archive-blog/2011/may/23/guardian190-prohibition-in-america">Prohibition</a>, embodied in the U.S Constitution’s 18th amendment, <a href="https://www.law.cornell.edu/constitution/amendmentxviii">banned the sale, manufacture and transportation of alcohol</a>. Yet it remained <a href="https://www.history.com/news/10-things-you-should-know-about-prohibition">legal to drink</a>, and <a href="https://www.smithsonianmag.com/history/tiny-french-archipelago-became-americas-illegal-warehouse-during-prohibition-180967868/">alcohol was widely available</a> throughout Prohibition, which ended in 1933.</p>
<p>I am reminded of how easy it was to drink during Prohibition every time I go to the <a href="https://www.omnihotels.com/hotels/bretton-woods-mount-washington/dining/the-cave">hotel in New Hampshire</a> that hosted the <a href="https://www.worldbank.org/en/about/archives/history/exhibits/bretton-woods-monetary-conference">Bretton Woods Conference</a>, which created the modern international monetary system after World War II. The hotel, now known as the Omni Mount Washington Resort, boasts a <a href="https://www.bostonglobe.com/lifestyle/travel/2015/09/12/breaking-law-north-country-speakeasy-the-cave-toasts-its-bootlegging-legacy/VmJPAyqjSfMwdQmH3izJZP/story.html">basement speakeasy</a> called <a href="https://www.omnihotels.com/hotels/bretton-woods-mount-washington/dining/the-cave">The Cave</a> that served illegal liquor during Prohibition. </p>
<p>The last time <a href="http://businessmacroeconomics.com/">I</a> was in The Cave I began wondering, given how prevalent Prohibition-era speakeasies appear to have been, what effect banning alcohol had on consumption rates. </p>
<p>Moreover, are we drinking any more today than we did before prohibition?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=597&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=597&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309859/original/file-20200114-103974-1owcgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=597&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bootleggers smuggled bottles of Scotch whiskey in hollowed-out loaves of bread.</span>
<span class="attribution"><span class="source">AP Photo</span></span>
</figcaption>
</figure>
<h2>Consumption begins to drop</h2>
<p>The <a href="http://prohibition.themobmuseum.org/the-history/the-road-to-prohibition/the-temperance-movement/">Prohibition movement began</a> in the early 1800s based on noble ideas such as boosting savings, reducing domestic violence and improving family life. </p>
<p>At the time, alcohol usage was soaring in the U.S. Some estimates by alcohol opponents put consumption at <a href="https://www.neh.gov/humanities/2011/septemberoctober/feature/going-dry">three times what it is today</a>. Activists thought that prohibiting its sale would curb excess drinking. Their efforts were very effective. </p>
<p>But while Prohibition is often portrayed as a sharp change that happened with <a href="https://www.pbs.org/kenburns/prohibition/roots-of-prohibition/">one last national call for drinks</a> just before the stroke of midnight, thousands of towns throughout the country <a href="https://www.neh.gov/humanities/2011/septemberoctober/feature/going-dry">had gone dry well before that</a>. More bans took effect during World War I in an effort to save grain. </p>
<p>So to consider the impact of Prohibition on drinking habits, it’s a good idea to start in the years leading up to it. And given that beer, wine and spirits all have different alcohol content, we’ll use the number of “standard” drinks a person consumes to make our comparison. A <a href="https://www.niaaa.nih.gov/what-standard-drink">standard drink contains</a> about 14 grams of pure alcohol. This is the amount of spirits in a 12 ounce beer, a five ounce glass of wine or a 1.5 ounce shot of hard liquor.</p>
<p>From 1900 until 1915 – five years before the 18th Amendment passed – the <a href="https://pubs.niaaa.nih.gov/publications/surveillance113/tab1_17.htm">average adult drank</a> about 2.5 gallons of pure alcohol a year, which is about 13 standard drinks per week. Consumption fell sharply by 1916, with the average falling to two gallons a year, or 10 drinks a week. </p>
<p>The Prohibition movement and the local dry laws that preceded it appeared to already be having an impact.</p>
<p><iframe id="mjDxu" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/mjDxu/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Drinking rebounds</h2>
<p>Tracking consumption gets a bit trickier after 1920. </p>
<p>Prohibition meant the federal government no longer had a way to measure how much alcohol people were consuming. So to get around the missing information, <a href="https://www.jstor.org/stable/2006862">researchers have used</a> data on arrests for drunkenness, deaths caused by cirrhosis of the liver, deaths by alcoholism and how many patients were admitted to hospitals for alcoholic psychosis. Put together, the numbers <a href="https://www.nber.org/papers/w3675">suggest alcohol consumption</a> dropped sharply in 1920, falling to about one-third of what people drank before Prohibition. </p>
<p>Starting in 1921, however, alcohol consumption rebounded quickly and soon reached about two-thirds of pre-Prohibition levels. One likely reason is that the U.S. experienced a <a href="https://www.u-s-history.com/pages/h1362.html">severe recession in 1920 and 1921</a>. When the economy recovered in 1922 to start the <a href="https://www.forbes.com/sites/timreuter/2014/10/21/how-to-succeed-in-business-and-government-without-really-trying-calvin-coolidge-and-the-roaring-twenties/#518032f31f60">roaring 20s</a> people were more able to afford illegal liquor.</p>
<p>In the decades after Prohibition ended on Dec. 5, 1933, with the repeal of the 18th Amendment, consumption remained relatively subdued. But by the 1960s and ‘70s, Americans were swilling just as much alcohol as in the early 1900s. </p>
<p><a href="https://pubs.niaaa.nih.gov/publications/surveillance113/tab1_17.htm">Today Americans drink on average</a> about 2.3 gallons of pure alcohol a year, which is about 12 standard drinks a week, about the same amount they drank before Prohibition. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309860/original/file-20200114-103954-vdm1yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Revelers in Chicago celebrate the end of Prohibition in 1933.</span>
<span class="attribution"><span class="source">AP Photo</span></span>
</figcaption>
</figure>
<h2>Prohibition’s legacy</h2>
<p>The era of Prohibition left many legacies. </p>
<p>One result is American’s <a href="http://theconversation.com/why-bland-american-beer-is-here-to-stay-91737">preference for pale bland beers</a>. Drinking also moved from public spaces like <a href="https:/www.doi.org/10.2105/AJPH.2005.065409">saloons into the home</a>.</p>
<p>More negatively, some claim it created organized crime as <a href="https://www.jstor.org/stable/1017691">violence soared</a> and <a href="http://prohibition.themobmuseum.org/the-history/the-rise-of-organized-crime/the-mob-during-prohibition/">mobsters enriched themselves</a>. It also meant states and the federal government, which relied heavily on excise taxes from liquor taxes to fund their budgets, <a href="https://www.pbs.org/kenburns/prohibition/unintended-consequences/">turned to income taxes</a> to help make up for the gap. And ultimately it did not result in a significant or lasting drop in alcohol consumption.</p>
<p>For these reasons, many people believe <a href="https://www.cato.org/sites/cato.org/files/pubs/pdf/pa157.pdf">it was a failure</a>, which should give pause to policymakers and others pushing for a ban on <a href="https://www.who.int/china/activities/banning-smoking-from-the-workplace">smoking</a> or <a href="https://time.com/5685936/state-vaping-bans/">vaping</a>. </p>
<p>And even the person most responsible for drafting Prohibition legislation, U.S. Rep. <a href="https://www.docsteach.org/documents/document/volstead-act">Andrew Volstead</a>, was <a href="https://www.alcoholproblemsandsolutions.org/hypocrisy-prohibition-alcohol-u-s/">no teetotaler</a> himself, suggesting even those who push such bans can’t even abide by them.</p>
<p>So, as an economist, I believe if you want to stop people from doing something injurious to their health, <a href="https://www.ncbi.nlm.nih.gov/books/NBK217454/">raising the price</a> works better than a ban. That’s how the U.S. <a href="https://www.forbes.com/sites/niallmccarthy/2018/07/26/poll-u-s-smoking-rate-falls-to-historic-low-infographic/#79cac19a3351">cut the share of adult smokers</a> from 40% in the 1970s to 16% by 2018.</p>
<p>The 100th anniversary of Prohibition reminds us that bans rarely work. </p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/129854/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jay L. Zagorsky 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>The era of Prohibition, which began in 1920 and ended in 1933, left many legacies – more modest drinking was not among them.Jay L. Zagorsky, Senior Lecturer, Questrom School of Business, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1279952019-12-29T21:02:06Z2019-12-29T21:02:06ZWhat causes hangovers, blackouts and ‘hangxiety’? Everything you need to know about alcohol these holidays<figure><img src="https://images.theconversation.com/files/307346/original/file-20191217-105097-2n9ct9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's no way to cure a hangover, even with 'hair of the dog'. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/N_R0X4H9uD4">Louis Hansel</a></span></figcaption></figure><p>With the holiday season well underway and New Year’s Eve approaching, you might find yourself drinking more alcohol than usual. </p>
<p>So what actually happens to our body as we drink alcohol and wake up with a hangover? </p>
<p>What about memory blackouts and “hangxiety”, when you can’t remember what happened the night before or wake up with an awful feeling of anxiety?</p>
<p>Let’s look at what the science says – and bust some long-standing myths.</p>
<h2>What happens when you drink alcohol?</h2>
<p>It doesn’t matter what type of alcohol you drink – or even whether you <a href="http://theconversation.com/is-mixing-drinks-actually-bad-87256">mix drinks</a> – the <a href="https://theconversation.com/do-different-drinks-make-you-different-drunk-88247">effects are basically the same</a> with the same amount of alcohol.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-different-drinks-make-you-different-drunk-88247">Do different drinks make you different drunk?</a>
</strong>
</em>
</p>
<hr>
<p>When you <a href="https://youtu.be/y1Y8Hig0L5s">drink alcohol</a> it goes into the stomach and passes into the small intestine where it’s quickly absorbed into the bloodstream. </p>
<p>If you have eaten something, it slows the absorption of alcohol so you don’t get drunk so quickly. That’s why it’s a good idea to eat before and during drinking.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/QHYlRc6-Gdw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>It takes your body about an hour to metabolise 10g, or one <a href="https://www.health.gov.au/health-topics/alcohol/about-alcohol/standard-drinks-guide">standard drink</a>, of alcohol. </p>
<p>(There are calculators that help you estimate your <a href="https://www.drinkfox.com/tools/bac-calculator/aus">blood alcohol level</a> but everybody breaks down alcohol at a <a href="http://www.responsibledrinking.org/what-happens-when-you-drink/how-you-drink-matters">different rate</a>. So these calculators should only be used as a guide.)</p>
<h2>What causes memory blackouts?</h2>
<p>We all have that friend who has woken up after a big night out and not been able to remember half the night. That’s a “blackout”.</p>
<p>It’s different to “passing out” – you’re still conscious and able to carry out conversation, you just can’t remember it later. </p>
<p>The more alcohol you drink and the faster you drink it, the more likely you are to experience blackouts.</p>
<p>Once alcohol in your blood reaches a certain level, your brain simply <a href="https://pubs.niaaa.nih.gov/publications/arh27-2/186-196.htm">stops forming new memories</a>. If you think of your brain like a filing cabinet, files are going straight to the bin, so when you later try to look for them they are lost.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/zSKsSrXXj7E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>How do I sober up?</h2>
<p>If you’ve had too much, there’s no way to sober up quickly. The only thing that can sober you up is time, so that the alcohol can be eliminated from your body.</p>
<p>The caffeine in coffee may make you feel <a href="https://www.alcoholproblemsandsolutions.org/how-can-i-sober-up-fast/">more awake</a>, but it doesn’t help break down alcohol. You will be just as intoxicated and impaired, even if you feel a little less drunk. </p>
<p>The same goes for cold showers, exercise, sweating it out, drinking water, and getting fresh air. These things might help you feel more alert, but they have no impact on your blood alcohol concentration or on the effects of alcohol.</p>
<h2>What causes hangovers?</h2>
<p>Researchers haven’t identified one single cause of hangovers, but there are a few possible culprits.</p>
<p>Alcohol is a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.1023">diuretic</a>, so it makes you urinate more often, which can lead to dehydration. This is especially the case if you’re in a hot, sweaty venue or dancing a lot. Dehydration can make you feel dizzy, sleepy and lethargic.</p>
<p>Alcohol can <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.1023">irritate your stomach lining</a>, causing vomiting and diarrhoea, and electrolyte imbalance. </p>
<p>An imbalance of electrolytes (the minerals our body need to function properly) can make you feel tired, nauseated, and cause muscle weakness and cramps. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307343/original/file-20191217-187622-48jkg3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hangovers can leave you tired, dehydrated, and with an irritated stomach.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/roCfgvkBLVY">Adrian Swancar/Unsplash</a></span>
</figcaption>
</figure>
<p>Too much alcohol can cause your blood vessels to dilate (expand), causing a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.1023">headache</a>. Electrolyte imbalance and dehydration can also contribute to that thumping head the next morning.</p>
<p>Alcohol also interferes with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.1023">glucose production</a>, resulting in low blood sugar. Not producing enough glucose can leave you feeling sluggish and weak.</p>
<p>Alcohol also <a href="https://www.sleepfoundation.org/articles/how-alcohol-affects-quality-and-quantity-sleep">disrupts sleep</a>. It can make you feel sleepy at first but it interrupts the circadian cycle, sleep rhythms and REM (rapid eye movement) sleep, so later in the night you might wake up. </p>
<p>It can stop you from getting the <a href="https://link.springer.com/article/10.1007/s41782-017-0008-7">quality of sleep</a> you need to wake feeling refreshed.</p>
<h2>Why ‘hair of the dog’ doesn’t work</h2>
<p>There’s no way to cure a hangover, even with “hair of the dog” (having a drink the morning after). But drinking the next morning might delay the onset of symptoms, and therefore make you feel better temporarily. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-you-can-cure-a-hangover-1518">Monday's medical myth: you can cure a hangover</a>
</strong>
</em>
</p>
<hr>
<p>Your body needs time to rest, metabolise the alcohol you have already had, and repair any damage from a heavy night of drinking. So it’s not a good idea.</p>
<p>If you drink regularly and you find yourself needing a drink the next morning, this may be a sign of alcohol dependence and you should talk with your GP. </p>
<h2>Suffering from hangxiety?</h2>
<p>Alcohol has many effects on the <a href="https://youtu.be/mUQZEhdgqko">brain</a>, including that warm, relaxed feeling after a couple of drinks. But if you’ve ever felt unusually anxious after a big night out you might have experienced “<a href="https://smartrecoveryaustralia.com.au/the-truth-about-hangxiety/">hangxiety</a>”.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/mUQZEhdgqko?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Over a night of drinking, alcohol stimulates the production of a chemical in the brain called GABA, which calms the brain, and blocks the production of glutamate, a chemical associated with anxiety. This combination is why you feel cheerful and relaxed on a night out.</p>
<p>Your brain likes to be in balance, so in response to drinking it produces more glutamate and blocks GABA. Cue that shaky feeling of anxious dread the next morning.</p>
<p><a href="https://www.beyondblue.org.au/personal-best/pillar/wellbeing/anxiety-after-drinking-and-what-you-can-do-about-it">What can you do</a> if you wake up with hangxiety?</p>
<p>To ease some of the symptoms, try some breathing exercises, some mindfulness practices and be gentle with yourself.</p>
<p>There are also effective treatments for anxiety available that can help. Talk to your GP or check out some <a href="https://www.beyondblue.org.au/get-support/online-forums/anxiety/hangxiety---help">resources online</a>.</p>
<p>If you’re already an anxious person, drinking alcohol may help you feel more relaxed in a social situation, but there is an even <a href="https://www.sciencedirect.com/science/article/pii/S0191886918305762?via%3Dihub#!">greater risk</a> that you will feel anxiety the next day.</p>
<h2>Prevention is better than a cure</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307344/original/file-20191217-187599-a6k8kz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Have a drink of water between alcoholic drinks.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/2SDjvx5jEZQ">Marvin Meyer/Unsplash</a></span>
</figcaption>
</figure>
<p>If you choose to drink this holiday season, the best way to avoid hangovers, hangxiety, and blackouts is to stick within <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">recommended limits</a>.</p>
<p>The new draft Australian alcohol guidelines recommend no more than ten standard drinks a week and no more than four standard drinks on any one day.</p>
<p>(If you want to check what a standard drink looks like, use <a href="https://yourroom.health.nsw.gov.au/games-and-tools/pages/standard-drink-calculator.aspx">this</a> handy reference.)</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cap-your-alcohol-at-10-drinks-a-week-new-draft-guidelines-128856">Cap your alcohol at 10 drinks a week: new draft guidelines</a>
</strong>
</em>
</p>
<hr>
<p>As well as eating to slow the absorption of alcohol, and drinking water in between alcoholic drinks to reduce the negative effects, you can also:</p>
<ul>
<li><p>set your limits early. Decide before you start the night how much you want to drink, then stick to it</p></li>
<li><p>count your drinks and avoid shouts</p></li>
<li><p>slow down, take sips rather than gulps and avoid having shots.</p></li>
</ul>
<p>If you’re worried about your own or someone else’s drinking, call the National Alcohol and other Drug Hotline on 1800 250 015 to talk through options or check out <a href="https://hellosundaymorning.org">resources online</a>.</p><img src="https://counter.theconversation.com/content/127995/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector, including education and training for parents on drugs. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She is also a member of board of directors of Hello Sunday Morning.</span></em></p><p class="fine-print"><em><span>Brigid Clancy works as a contractor to a private alcohol and other drug consultancy.</span></em></p>Most of us wake up with a hangover after a big night. But some people also wake up with awful anxiety (‘hangxiety’) and can’t remember much of the night before because of memory blackouts. Here’s why.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityBrigid Clancy, PhD Candidate (Psychiatry) & Research Assistant, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1246302019-12-20T16:56:16Z2019-12-20T16:56:16ZHangovers happen as your body tries to protect itself from alcohol’s toxic effects<figure><img src="https://images.theconversation.com/files/308125/original/file-20191220-11904-o6bx4v.jpg?ixlib=rb-1.1.0&rect=365%2C121%2C4409%2C3063&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A night of revelry can mean an uncomfortable day after.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/migraine-headache-227278786">Everett Collection/Shutterstock.com</a></span></figcaption></figure><p>Debaucherous evening last night? You’re probably dealing with veisalgia right now.</p>
<p>More commonly known as a hangover, this unpleasant phenomenon <a href="https://time.com/3958046/history-of-hangovers/">has been dogging humanity</a> since our ancestors first happened upon fermentation.</p>
<p>Those nasty vertigo-inducing, cold sweat-promoting and vomit-producing sensations after a raucous night out are all part of your body’s attempt to protect itself from injury after you overindulge in alcoholic beverages. Your liver is working to break down the alcohol you consumed so your kidneys can clear it out ASAP. But in the process, your body’s inflammatory and metabolic reactions are going to lay you low with a hangover.</p>
<p>As long as people have suffered from hangovers, they’ve searched in vain for a cure. Revelers have access to a variety of compounds, products and devices that purport to ease the pain. But there’s a lot of purporting and not a lot of proof. Most have not been backed up well by science in terms of usefulness for hangover treatment, and often their effects don’t seem like they’d match up with what scientists know about the biology of the hangover.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308010/original/file-20191219-11900-1nrkesq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drain enough cups of booze in one session and you know what’s bound to follow.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/EEIIm23ktS4">Laura buron/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Working overtime to clear out the booze</h2>
<p>Hangovers are virtually guaranteed when you drink too much. That amount varies from person to person based on <a href="https://doi.org/10.1111/add.12699">genetic factors</a> as well as whether there are <a href="https://doi.org/10.1111/j.1530-0277.2009.01116.x">other compounds</a> that formed along with ethanol in the fermentation process.</p>
<p>Over the course of a night of heavy drinking, your blood alcohol level continues to rise. Your body labors to break down the alcohol – consumed as ethanol in beer, wine or spirits – forming damaging oxygen free radicals and acetaldehyde, itself a harmful compound. The longer ethanol and acetaldehyde stick around, the more damage they can do to your cellular membranes, proteins and DNA, so your body’s enzymes work quickly to metabolize acetaldehyde to a less toxic compound, acetate.</p>
<p>Over time, your ethanol levels drop through this natural metabolic process. Depending on how much you consumed, you’re likely to experience a hangover as the level of ethanol in your blood slowly returns to zero. Your body is withdrawing from high levels of circulating alcohol, while at the same time trying to protect itself from the effects of alcohol.</p>
<p>Scientists have limited knowledge of the leading causes of the hangover. But they do know that the body’s responses include changes in hormone levels to <a href="https://www.pulsus.com/abstract/alcohol-hangover-its-effects-on-human-body-review-4404.html">reduce dehydration</a> and cellular stress. Alcohol consumption also affects a variety of <a href="https://doi.org/10.1093/alcalc/agz016">neurotransmitter systems</a> in the brain, including glutamate, dopamine and serotonin. Inflammation increases in the body’s tissues, and the healthy gut bacteria in your digestive system take a hit too, promoting <a href="https://doi.org/10.1093/alcalc/agy061">leaky gut</a>.</p>
<p>Altogether, <a href="https://doi.org/10.1093/alcalc/agz016">the combination of all these reactions</a> and protective mechanisms activated by your system gives rise to the experience of a hangover, which can last up to 48 hours.</p>
<h2>Your misery likely has company</h2>
<p>Drinking and socializing are cultural acts, and most hangovers <a href="https://doi.org/10.1080/13676261.2012.693594">do not happen in isolation</a>. Human beings are social creatures, and there’s a high likelihood that at least one other individual feels the same as you the morning after the night before.</p>
<p>Each society has different rules regarding alcohol use, which can affect how people <a href="https://doi.org/10.1016/j.puhe.2011.09.014">view alcohol consumption within those cultures</a>. Drinking is often valued for its relaxing effect and for promoting sociability. So it’s common to see alcohol provided at celebratory events, social gatherings and holiday parties.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=638&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=638&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=638&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=802&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=802&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308014/original/file-20191219-11939-1p3ym3k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=802&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For many people, ‘partying’ is synonymous with ‘drinking.’</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/BnzqQwerUOY">Lidya Nada/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In the United States, drinking alcohol is largely embraced by mainstream culture, which may even promote behaviors involving <a href="https://doi.org/10.1186/1471-2458-9-51">excessive drinking</a>. It should be no surprise that overindulgence goes hand in hand with these celebratory social events – and leads to hangover regrets a few hours later. </p>
<p>Your body’s reactions to high alcohol intake and the sobering-up period can influence mood, too. The combination of fatigue that you experience from sleep deprivation and hormonal stress reactions, in turn, affect your neurobiological responses and behavior. As your body is attempting to repair itself, you’re more likely to be easily irritated, exhausted and want nothing more than to be left alone. Of course, your <a href="https://doi.org/10.2174/1874473711003020080">work productivity takes a dramatic hit</a> the day after an evening of heavy drinking.</p>
<p>When all is said and done, you’re the cause of your own hangover pain, and you’re the one who must pay for all the fun of the night before. But in short order, you’ll <a href="https://doi.org/10.1016/j.addbeh.2008.06.014">forget how excruciating your last hangover</a> was. And you may very soon talk yourself into doing the things you swore you’d never do again.</p>
<h2>Speeding up recovery</h2>
<p>While pharmacologists <a href="https://scholar.google.com/citations?user=miPd9ysAAAAJ&hl=en&oi=ao">like</a> <a href="https://scholar.google.com/citations?user=ZLL4yjwAAAAJ&hl=en&oi=ao">us</a> understand a bit about how hangovers work, we still lack a true remedy.</p>
<p>Countless articles describe a <a href="http://www.cjhp.org/volume16Issue1_2018/documents/79-90_CJHP2018Issue1_Kruger.pdf">variety of foods</a>, caffeine, ion replenishment, <a href="https://doi.org/10.1016/j.neulet.2018.01.030">energy drinks</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/30462386">herbal supplements</a> including <a href="https://doi.org/10.3390/molecules21010064">thyme and ginger, vitamins</a> and the “hair of the dog” as ways to <a href="https://doi.org/10.1002/hup.2600">prevent and treat hangovers</a>. But the evidence isn’t really there that any of these work effectively. They’re just not scientifically validated or well reproduced.</p>
<p>For example, Kudzu root (<em>Pueraria lobata</em>), a popular choice for hangover remedies, has primarily been investigated for its effects in reducing alcohol-mediated stress and hangover. But at the same time, Kudzu root appears to <a href="https://doi.org/10.1016/j.alcohol.2007.07.009">inhibit the enzymes that break down acetaldehyde</a> – not good news since you want to clear that acetaldehyde from your system quickly.</p>
<p>To fill this knowledge gap, our lab is <a href="https://pharmacyschool.usc.edu/directory/?expert=jing.liangphd">working with colleagues</a> to see if we can find scientific evidence for or against potential hangover remedies. We’ve focused on the benefits of dihydromyricetin, a Chinese herbal medicine that is currently available and formulated as a dietary supplement for hangover reduction or prevention.</p>
<p>Dihydromyricetin appears to work its magic by <a href="https://www.ncbi.nlm.nih.gov/pubmed/17048612">enhancing alcohol metabolism</a> and reducing its toxic byproduct, acetaldehyde. From our findings in mice models, we are collecting data that support the usefulness of dihydromyricetin in <a href="http://www.koreascience.or.kr/article/JAKO200003042335835.page">increasing the expression and activity of enzymes</a> responsible for ethanol and acetaldehyde metabolism in the liver, where ethanol is primarily broken down. These findings explain one of the several ways dihydromyricetin protects the body against alcohol stress and hangover symptoms. </p>
<p>We are also studying how this enhancement of alcohol metabolism results in changes in alcohol drinking behaviors. Previously, dihydromyricetin was found to counteract the relaxation affect of drinking alcohol by interfering with particular neuroreceptors in the brain; <a href="https://doi.org/10.1523/JNEUROSCI.4639-11.2012">rodents didn’t become as intoxicated</a> and consequently reduced their ethanol intake. Through this combination of mechanisms, we hope to illustrate how DHM might reduce the downsides of excessive drinking beyond the temporary hangover, and potentially reduce drinking behavior and damage associated with heavy alcohol consumption.</p>
<p>Of course, limiting alcohol intake and substituting water for many of those drinks during an evening out is probably the best method to avoid a painful hangover. However, for those times when one alcoholic beverage leads to more than a few more, be sure to stay hydrated and catch up on rest. Your best bet for a smoother recovery is probably some combination of <a href="https://doi.org/10.1016/j.alcohol.2019.10.006">nonsteroidal anti-inflammatory drug</a> like ibuprofen, Netflix and a little downtime. </p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/124630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Davies received a Donation from 82 Labs two years ago to conduct basic research on DHM that is mentioned in the article. </span></em></p><p class="fine-print"><em><span>Joshua Silva and Terry David Church do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers know the basic biology of what happens to your system after a night of heavy drinking. Unfortunately, evidence-based cures for the common hangover are still at the investigation stage.Daryl Davies, Professor of Clinical Pharmacy, University of Southern CaliforniaJoshua Silva, Ph.D. Candidate in Clinical and Experimental Therapeutics, University of Southern CaliforniaTerry David Church, Assistant Professor of Regulatory and Quality Sciences, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1273132019-11-21T19:42:19Z2019-11-21T19:42:19ZBrain activity predicts which mice will become compulsive drinkers<figure><img src="https://images.theconversation.com/files/302787/original/file-20191120-515-1yve1an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Can the activity in brain circuits predict who is vulnerable to excessive drinking?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/brain-glass-alcohol-drink-alcoholism-concept-600714989">AlexLMX/Shutterstock.com</a></span></figcaption></figure><p>Some individuals consume alcohol their entire adult life without developing an alcohol use disorder. Others, however, quickly transition to compulsive and problematic drinking. Can we determine what makes some people vulnerable to addiction?</p>
<p>Alcohol drinking is the <a href="https://doi.org/10.1001/jama.291.10.1238">third leading cause of preventable death</a> in the United States, and is responsible for millions of deaths per year worldwide. If the reasons why some people are susceptible to alcohol use disorder were known, it might be possible to more effectively treat this devastating disease, or even intervene before serious problems emerge. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=612&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=612&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=612&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=769&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=769&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302955/original/file-20191121-483-10fu3vw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=769&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How much drinking is excessive?</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/alcohol/onlinemedia/infographics/excessive-alcohol-use.html">CDC</a></span>
</figcaption>
</figure>
<p>I have <a href="https://scholar.google.com/citations?hl=en&user=JJ14QfUAAAAJ">spent my career</a> as a neuroscientist and pharmacologist trying to understand how drugs and alcohol act on the brain, and what makes a brain more or less susceptible to substance use disorders. <a href="https://sicilianolab.com">My laboratory</a> at the <a href="https://medschool.vanderbilt.edu/vcar/">Vanderbilt Center for Addiction Research</a> develops approaches for studying addictive behaviors in rats and mice. Using <a href="https://sicilianolab.com/research/techniques">electrochemical and optical approaches</a> to measure brain activity, our goal is to determine how patterns of activity in brain cells give rise to these behaviors – and how we may use this information to treat or prevent substance use disorders. </p>
<p>In a report published in the <a href="https://science.sciencemag.org/lookup/doi/10.1126/science.aay1186">Nov. 22 issue of the journal Science</a>, <a href="https://www.salk.edu/scientist/kay-tye/">Kay Tye of the Salk Institute</a> and I set out to understand how binge drinking alters the brain and how this can lead to compulsive behaviors in some drinkers. </p>
<h2>Testing for compulsive drinking</h2>
<p>To study this, we designed an experiment in which mice were scored for their propensity to drink alcohol. We measured compulsive drinking by determining how much they drank when we mixed the alcohol with a bitter tasting substance that mice normally avoid. </p>
<p>After assessing levels of compulsive drinking in each mouse, mice were allowed to binge drink for several weeks, during which they consumed large amounts of alcohol daily. Then compulsive drinking was measured again. This allowed for tracking the development of excessive and compulsive drinking behaviors across time and experience.</p>
<p>Initially, all of the mice in our experiment had very similar drinking behaviors. However, even though the mice were all genetically identical, after binge drinking there was wide variability that enabled us to divide the mice into three distinct groups. After binge drinking, some mice drank large amounts, and continued to drink even when the alcohol was made bitter. We classified these mice as “compulsive drinkers.” The next group was designated as “high drinkers.” These mice drank large amounts of alcohol, but quickly stopped when the alcohol was bitter. “Low drinkers” had the lowest levels of alcohol consumption under both conditions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=233&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=233&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=233&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=293&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=293&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302956/original/file-20191121-524-lxp9k2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=293&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What is considered a single serving of a drink?</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/alcohol/onlinemedia/infographics/excessive-alcohol-use.html">CDC</a></span>
</figcaption>
</figure>
<h2>Brain circuit activity predicts compulsive drinking</h2>
<p>We wanted to understand how a group of neurons connecting two brain regions, called the medial prefrontal cortex and the dorsal periaqueductal gray area, contribute to compulsive drinking behaviors. The prefrontal cortex is involved in decision making; the dorsal periaqueductal gray area processes painful and aversive events.</p>
<p>We reasoned that the communication between these two regions might be critical in determining how subjects make decisions when negative outcomes (like bitter taste) are paired with drinking. Using an approach called <a href="https://static1.squarespace.com/static/5d27c543eea0d500016ccf1d/t/5d6ebf3ea2517200013d331c/1567539009396/leveraging-calcium-imaging-to-illuminate-circuit-dysfunction-in-addiction.pdf">calcium imaging</a>, we were able to observe the activity of these neurons while the mice drank.</p>
<p>The initial hypothesis was that binge drinking would disrupt the ability of this neural circuit to respond appropriately to events in the environment. However, we were surprised to discover early on in these experiments that each of the three groups of mice had very distinct brain activity patterns the first time the mice drank alcohol, even though the behavior of these three groups of mice was the same at this point in time. </p>
<p>Mice that progressed to become compulsive showed less brain activity in this pathway during early exposure to alcohol. Those that showed little interest in alcohol and were easily put off by the bitter taste showed increased activity in these same neurons during drinking.</p>
<p>By examining the neural response to alcohol prior to the binge drinking, we could predict which mice would eventually become compulsive drinkers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303008/original/file-20191121-524-1daixd6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cells in the medial prefrontal cortex are labeled in blue. The medial prefrontal cortex neurons that connect and send messages to the dorsal periaqueductal gray area are labeled in green.</span>
<span class="attribution"><span class="source">Cody Siciliano</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Altering drinking behaviors</h2>
<p>In a separate experiment, we used a technique called optogenetics, where light-sensitive proteins are introduced to the mouse’s brain cells so that their activity can be controlled with pulses of light, to manipulate the activity of this population of neurons.</p>
<p>By artificially reproducing the brain activity patterns we observed in the compulsive mice, we were able to cause compulsive drinking behaviors even in mice that had never had a binge drinking experience. Conversely, by driving excitatory activity in these neurons during alcohol drinking, just like we observed in the low drinking animals, we were able to decrease drinking. </p>
<p>It seems as if this medial prefrontal cortex-dorsal periaqueductal gray circuit acts like a gate for compulsive drinking. When there is increased activity in these brain cells during alcohol drinking, a mouse is less likely to drink again in the future. When there is decreased activity during drinking, the mice are prone to drink again, even if that means suffering a negative consequence. What causes these differences in activity in individual mice is still unclear.</p>
<p>Although much more research is required before these findings can be applied to humans, we believe this study provides critical insights into the neurobiological mechanisms that predispose some users to alcohol use disorders. </p>
<p>Understanding the neural mechanisms controlling the behavioral processes that ultimately lead to substance use disorder is the critical first step to developing treatments to reduce excessive alcohol drinking. Importantly, these findings suggest that may we may be able to identify at risk individuals, based on neural activity patterns, and intervene before an alcohol use disorder fully develops. </p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/127313/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cody A. Siciliano receives funding from the National Institutes of Health, and the Brain and Behavior Research Foundation. </span></em></p>One in six US adults binge drinks, consuming about seven drinks per binge. A new study can predict which mice are hardwired to binge drink. Is it possible to do the same for humans?Cody A. Siciliano, Assistant Professor of Pharmacology, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1204612019-08-21T15:46:27Z2019-08-21T15:46:27ZLiver disease: how new intelligent testing could save thousands of lives<figure><img src="https://images.theconversation.com/files/288801/original/file-20190820-170914-1kn0n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-people-friends-hanging-out-drinking-336896096">Shutterstock</a></span></figcaption></figure><p>Since the 1970s, liver disease in the UK has <a href="https://www.bmj.com/content/352/bmj.i124">increased</a> by more than 400%, particularly in people under 65 – in marked contrast to all other major causes of death which have been decreasing in younger age groups. This epidemic has been driven by alcohol, obesity and <a href="https://www.nhs.uk/conditions/hepatitis-c/">hepatitis C</a>.</p>
<p>The liver is the factory of the body, making vital proteins and breaking down waste products or excreting them. Liver disease is usually a silent disease in its early stages. Liver function tests (LFTs) are routinely available blood tests associated with liver damage, so should be able to detect liver problems early on. Millions of these tests are performed each year in the UK by doctors and nurses for a multitude of symptoms and problems ranging from feelings of tiredness, to yellowing of skin (in white people) or the whites of the eyes, due to <a href="https://www.nhs.uk/conditions/jaundice/">jaundice</a>.</p>
<p>LFTs are commonly abnormal due to a variety of reasons, such as drinking too much, fatty liver caused by obesity, infections, rare liver diseases and some cancers – but they can be a sign of curable potentially fatal liver disease. </p>
<p>But it is complex to sort out what to do about them – many people with abnormal LFTs are not investigated because of the complex pattern of investigation. In those who are, current care is geared to find an explanation via a lengthy process of investigation and ruling things out, with costs to patients and the NHS in terms of money and time – many people drop out along the way.</p>
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<img alt="" src="https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=266&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=266&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=266&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=334&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=334&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288802/original/file-20190820-170946-3hb8hf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=334&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="license">Author provided</span></span>
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<p>This misses an opportunity to diagnose and treat liver disease at an early stage. With the dramatic rise in the rate of testing and the number of resulting abnormalities, this is not sustainable. So how do we investigate the abnormal LFTs to maximise health gain and minimise health costs?</p>
<h2>Rules, clinical facts and algorithms</h2>
<p>We use a smarter application of existing knowledge and technology. To solve the problem, we developed a set of rules for the diagnosis of many liver diseases using only blood results – for both the cause of the liver damage as well the severity of it – combined with simple clinical facts, such as alcohol intake and body mass index.</p>
<p>In effect, we reduced what a liver specialist does when they see a patient to a set of rules that could be used to create algorithms that would give a specific diagnosis to many patients, and a helpful management plan to the rest who may need to manage lifestyle factors. We went on and <a href="https://www.journal-of-hepatology.eu/article/S0168-8278(19)30354-X/abstract">tested this set of rules</a> to show that they did work as well as actually consulting a liver specialist.</p>
<p>The other component that allows our new system to work is in the blood sciences laboratory. When a blood sample arrives in the lab, it has a bar code and is placed on a large track system, like a model train track. A computer directs the sample to all the machines it needs to go through to have all the required tests performed. The computer also has the ability to change what happens to the sample depending on the first results.</p>
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<img alt="" src="https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288803/original/file-20190820-170922-1ywhc2h.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>So we created “intelligent liver function testing” or “iLFT”. In the new system the GPs who suspected liver disease in a patient selected the intelligent LFT pathway in the lab test requesting system and entered clinical details – BMI, alcohol intake and presence of high blood pressure, high cholesterol or diabetes. The algorithm was integrated with the lab’s information management system, allowing appropriate biochemistry, haematology, virology and immunology tests to cascade if the initial LFTs were abnormal.</p>
<p>The iLFT algorithm then combined the clinical information, test results and fibrosis (the extent to which tissue is damaged) scores to generate a diagnosis and/or management plan available as a web link for quick access on the GPs computer. The system generates 32 outcomes, varying from a clear cut diagnosis to a description of what has been found and suggestions for further investigation. This maximises the diagnosis of early liver disease. iLFT uses a synthesis of existing evidence combined with new algorithms that can be integrated into current lab biochemical analysers and technology to produce a diagnosis in many patients.</p>
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<span class="attribution"><span class="license">Author provided</span></span>
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<p>So on any sample sent for LFTs it would be possible to generate a diagnosis or prognosis. The system was trialled and showed that all patients can be investigated, increasing diagnosis of liver disease by 44%, and over an average patient lifetime this is an average saving of £3,216 per head.</p>
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<img alt="" src="https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=281&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=281&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=281&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=353&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=353&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288805/original/file-20190820-170918-do56ct.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=353&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>In a system that is currently failing to offer a diagnosis to all patients with abnormal results on their liver function tests, iLFT increases diagnosis, improves quality of care and is cost effective. A switch to this new system could be achieved with minor changes to working practices and existing lab systems. iLFT has won multiple awards and is now the standard care in NHS Tayside – and other units and hospitals across the UK are now exploring its potential for their own patients.</p><img src="https://counter.theconversation.com/content/120461/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Dillon receives funding from chief scientist's office of the Scottish department of health. </span></em></p>A new test which capitalises on existing knowledge and technology will increase diagnoses, speed up the process and save the NHS millions of pounds.John Dillon, Professor of Hepatology and Gastroenterology, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188222019-07-04T07:06:44Z2019-07-04T07:06:44ZHow rehab helps heavy drug and alcohol users think differently<figure><img src="https://images.theconversation.com/files/282639/original/file-20190704-126391-11u9iqh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Living in a group environment is part of learning how to manage without using drugs.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around 16,700 Australians stay in residential rehabilitation centres each year, most commonly for problems with alcohol, amphetamines <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/aodts-2017-18-key-findings/contents/treatment">and opiates</a>. </p>
<p>Rehab is a structured, drug- and alcohol-free environment. Residents participate in the same daily and weekly routines and activities, including educational and therapeutic groups and individual counselling sessions. Household chores, cooking, exercise, education and recreational activities fill the time. </p>
<p>Some rehabs have as few as 12 residents at one time, others have as many as 60. Programs last from six weeks to 18 months, with eight weeks the average in Australia.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30925888">Our recent study</a> of 12 rehab residents in Australia found the safe, structured environment and the support of others going through the same experience were key to helping residents change their thinking about drug and alcohol use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-what-works-and-what-to-keep-in-mind-when-choosing-a-private-treatment-provider-95431">Drug rehab: what works and what to keep in mind when choosing a private treatment provider</a>
</strong>
</em>
</p>
<hr>
<h2>Safety and routine</h2>
<p>We asked people what program elements they thought were important. They most often talked about the safe environment, structured routines and staff support. As one woman explained, “I love my room, it’s my space. I am safe there.”</p>
<p>Living in a group environment with strangers while fighting mood swings and cravings is tough. The staff maintained the routines and monitored the group dynamics but they also responded to individual needs for support: </p>
<blockquote>
<p>I’ve had down days and they’re (staff) pretty quick to pick it up. I’m not the sort of person that likes to talk about emotions and let it out, but they’re pretty quick. The times I’ve been down, they pick it up pretty quick.</p>
</blockquote>
<p>Living in a group environment is part of learning how to manage without using drugs. Critical changes that study participants attributed to the program were about dealing with their own and others’ emotions:</p>
<blockquote>
<p>I think, what I’ll take away is to understand that that’s the person I am and I’ll manage it. To understand my feelings, like when I am angry, to get away from the situation and take a breath and understand my feelings, I guess. Just understand what I’m feeling. If I’m angry, I know there’s other options than to go use, or drink.</p>
</blockquote>
<h2>A new way of living</h2>
<p>Most participants described the shared experience of everyday life without drugs or alcohol for an extended period as particularly important. One woman said:</p>
<blockquote>
<p>we’d sit around laughing our heads off and actually we’d say we’ve probably never laughed so much in our lives. We were just sitting around with no alcohol, no drugs and just making do with what we’ve got.</p>
</blockquote>
<p>For many, that change was unexpected: </p>
<blockquote>
<p>There was no drugs or alcohol involved and pretty much the first time since I was a young teenager, I realised you can be happy. I don’t know. It was just a bit of a change in life. </p>
</blockquote>
<p>Rehab programs are not usually designed around a specific type of drug or individual. The same therapies are applied to everyone. </p>
<p>The group content used in the rehab we studied included health and well-being education and psychological therapies intended to help people deal with triggers and make decisions around drug use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-and-group-therapy-do-they-work-65413">Drug rehab and group therapy: do they work?</a>
</strong>
</em>
</p>
<hr>
<p>However, the most important thing for most people was a daily, group-based reflection on personal values which helped create a different view of themselves as, say, a mother or friend. As one man said:</p>
<blockquote>
<p>so it makes me look at myself, like I’m forgiving and humility, and really looking at me and going, okay, well, I’m not such a crap person, because I’m an addict. I’ve got some good values there.</p>
</blockquote>
<h2>Possibility of relapse</h2>
<p>Fear and anxiety about relapse after leaving rehab were common. People felt vulnerable to resuming drug use despite gains made during the program and their desires to remain substance-free:</p>
<blockquote>
<p>I’m getting a bit anxious, knowing that I’m going. I’ve been here, wrapped in cotton wool for two months, and being released back into the big, wide world, I’m scared that I’m going to relapse.</p>
</blockquote>
<p>Few study participants had support to cope in the future. Friends and social groups were limited because past connections usually involved drug use: </p>
<blockquote>
<p>That’s going to be the hardest thing for me, seeing old mates and them asking if I want some. That’s the hardest part. You are who you hang around. It’s sad to say, but I’ve started hanging around some pretty ordinary people. You think they’re your friends but they’re not.</p>
</blockquote>
<p>Maintaining change after rehab is a challenge and few supports are available. </p>
<p>Relapse rates are high. Most people use drugs in the year after treatment. Between 40% and 60% <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000386">return to substance dependence</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">What is 'success' in drug rehab? Programs need more than just anecdotes to prove they work</a>
</strong>
</em>
</p>
<hr>
<h2>The downsides</h2>
<p>Several people described being fearful of what would happen when they got there. Others described conflicts between residents and lack of contact with children as challenges they faced.</p>
<p>Cost can also be an issue. The centre we studied charged A$240 a week for all facilities including therapeutic programs. But private rehabs are also available and can cost as much as A$30,000 a <a href="https://www.smh.com.au/national/money-makes-all-the-difference-when-it-comes-to-tackling-ice-addiction-in-victoria-20150210-13b2ic.html">month</a>.</p>
<p>Rehab fills the day and provides intensive support for people but that doesn’t exist when they go home. </p>
<p>Community support programs like counselling, employment and drug-free social and recreational programs, which bring safe family members and friends back into the picture, could reduce relapse.</p><img src="https://counter.theconversation.com/content/118822/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan has received funding from NHMRC, ARC, Ian Potter Foundation, NSW Health to conduct research on services for people who use drugs. Julaine has worked for Lives Lived Well, a not for profit drug and alcohol service provider.</span></em></p><p class="fine-print"><em><span>Dr Alice Munro receives funding from NSW Health. </span></em></p><p class="fine-print"><em><span>Susan Collings receives funding from NSW Family and Community Services</span></em></p>Residential drug rehab programs usually last for around eight weeks and include everything from counselling sessions to household chores, which help build connections and support between residents.Julaine Allan, Senior research fellow, Charles Sturt UniversityAlice Munro, Conjoint Research Associate, National Drug and Alcohol Research Centre, UNSW SydneySusan Collings, Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1133252019-03-13T14:32:52Z2019-03-13T14:32:52ZHuman Genome Project: new alcohol abuse study could help us finally unlock secrets to beating genetic diseases<figure><img src="https://images.theconversation.com/files/263596/original/file-20190313-123528-139jx6v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Strand ahoy!</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/dna-3d-illustration-80855953">Image Wizard</a></span></figcaption></figure><p>Human Genome Project has not lived up to the hype on beating disease, but new alcohol abuse study could change that </p>
<p>It is almost 20 years since Bill Clinton joined Tony Blair <a href="https://www.genome.gov/10001356/june-2000-white-house-event/">to announce</a> the first rough sequencing of the human genome to <a href="http://news.bbc.co.uk/1/hi/sci/tech/805803.stm">tremendous fanfare</a> in June 2000. The president gushed at the audience in the White House:</p>
<blockquote>
<p>We are gaining ever more awe for the complexity, the beauty, the wonder of God’s most divine and sacred gift. With this profound new knowledge, humankind is on the verge of gaining immense, new power to heal.</p>
</blockquote>
<p>This hasn’t happened yet, however. We have identified the genetic basis of a few rare pathologies, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251168/">such as this</a> cognitive impairment, but our understanding of leading diseases including cancer, heart disease and diabetes seems little better than at the start of the century. The good news is that there might finally be a way forward – but first, the story so far. </p>
<p>The <a href="https://www.sciencedaily.com/terms/human_genome.htm">human genome</a> is the collection of DNA that contains the recipe for who we are as individuals. Sequencing it has certainly brought benefits. We have determined the true number of genes it contains, plus their structure and function – all of which was seen as essential to understanding our susceptibility to all genetic conditions, from cancers to insomnia. </p>
<p>This threw up some major surprises. Because of our intellectual superiority to other mammals, geneticists used to think we needed at least 100,000 genes to listen to Bach or discern fine wine. But it turned out that all mammals, from mice to humans, share the same suite of about 20,000 genes. Having digested this discovery, at least it pointed to an opportunity: fewer genes meant an easier search for disease-causing gene mutations – particularly since it also turned out that genes only comprised 2% of the genome. </p>
<h2>The stumbling block</h2>
<p>Geneticists tried to exploit the revelations about the genome with <a href="https://www.ebi.ac.uk/training/online/course/gwas-catalog-exploring-snp-trait-associations/why-do-we-need-gwas-catalog/what-are-genome">studies</a> that combed through thousands of tiny genetic changes in hundreds of thousands of patients with different diseases to see how they compared to healthy people. This enabled them to correlate genetic changes in diseased DNA in a manner unimaginable before June 2000. The “genetic architecture” of a wide number of conditions from cancers to schizophrenia to addiction became much better understood as a result. </p>
<p>Yet after the first few thousand studies were published, geneticists were horrified to <a href="https://www.ncbi.nlm.nih.gov/pubmed/28622505">discover that</a> 98% of the disease-associated changes they’d identified in the genome do not occur in the genes. Instead, the vast majority of changes related to disease occur in the 98% of the genome that is not made up of genes – known as the “junk genome”, since few had the foggiest notion of what it was or how to study it. </p>
<p>At this point, a white knight appeared in the form of 440 scientists around the world known as the <a href="https://www.encodeproject.org">ENCODE consortium</a>. Headquartered at Stanford, ENCODE spent some US$400m (£307m) <a href="http://betastuffs.blogspot.com/2012/09/highly-detailed-map-of-human-genome.html?m=1">preparing</a> a much vaunted “Encyclopaedia of the Human Genome”, amassing huge amounts of data to figure out what was going on in the junk genome. </p>
<p>Among various contentious claims, the consortium subsequently <a href="https://www.ncbi.nlm.nih.gov/pubmed/23431001">proclaimed</a> that <a href="https://www.ncbi.nlm.nih.gov/pubmed/15499007">at least</a> 10% of the human genome was made up of genetic switches called <a href="https://www.nature.com/scitable/definition/enhancer-163">enhancers</a> that activate and deactivate genes. But if these sounded like the key to conquering genetic diseases, difficulties soon emerged. </p>
<p>Scientists <a href="https://www.ncbi.nlm.nih.gov/pubmed/25635462">suggested that</a> these complex sequences of DNA continually evolve at a high speed, implying they are not as important as genes. They may also be unique to individual species rather than being common to many. Together with findings that enhancers seemed to be quite transient and ephemeral in the genome, it began to look like our ability to quickly understand the human genome may have been overhyped. </p>
<h2>An alternative approach</h2>
<p>Some geneticists, including myself, are <a href="https://www.nature.com/articles/s41588-017-0018-3">now questioning</a> this received wisdom. This relates to the way that scientists have identified enhancers up to now: where we can recognise genes very clearly <a href="http://www.brooklyn.cuny.edu/bc/ahp/BioInfo/GP/GeneticCode.html">using</a> a system of three-letter codes, ENCODE identified enhancers using biochemical marker tests – as did the studies that later raised difficulties with these switches. </p>
<p>Yet there arguably isn’t enough evidence to be confident that “enhancer markers” in these tests accurately identify all the enhancers on the genome. More fundamentally, using the markers presupposes that enhancers should behave uniformly. If instead they are only active in specific cells at specific times, biochemical marker tests will not always be accurate, since they cannot reflect the activity of all enhancers in the very specific regions in which they are active. If so, enhancers may be conserved in the genomes of many more species than previous biochemical marker studies suggested. </p>
<p>To test this idea, the universities of Aberdeen and Edinburgh have been collaborating to identify the genetic causes of anxiety and alcohol abuse, <a href="https://www.who.int/en/news-room/fact-sheets/detail/alcohol">which kills</a> 7.7% of men and 2.6% of women around the world. To do this we studied mice – since they too can be susceptible to alcoholism when they are exposed to alcohol. </p>
<p>There is a gene called GAL that produces a small neuropeptide called galanin, which affects alcohol intake. Yet we knew that when you compare people who drink heavily with those who don’t, you don’t see differences in the GAL gene. By studying mice, we identified what appeared to be an enhancer that turned this gene on in specific regions of their brain. </p>
<p>We compared the genome sequences of 100 animal species, including humans, mice and birds, and found the same suspected enhancer on the genome, in nearly the same position, some distance from the gene. With the evolutionary branches of birds and men having separated some 310m years ago, the fact that this entity had survived made it extremely likely that it is central to alcohol abuse. </p>
<p>To test this, we used <a href="https://ghr.nlm.nih.gov/primer/genomicresearch/genomeediting">new gene-editing technology</a> to delete the enhancer in mice. Sure enough, we found that our gene-edited mice drank far less than normal mice after a week of alcohol exposure. They also became less anxious – albeit only the males. With the help of human genetic studies at the University of Edinburgh, this enabled us to <a href="https://www.biorxiv.org/content/10.1101/572065v1?rss=1">conclude that</a> in humans the same enhancer plays an important role in controlling people’s mood and alcohol intake. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/263659/original/file-20190313-123522-19lyc0s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘This’ll go with the camembert.’</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-rat-isolated-on-background-7591453">Indigo Fish</a></span>
</figcaption>
</figure>
<p>This is the first time anyone has shown that the same enhancer controls alcohol intake and mood in a wide number of species. It suggests that enhancers with important functions can be detected in the human genome by looking at the extent to which they exist across different species. Far from being the transient and ephemeral entities suggested by biochemical marker studies, our work demonstrates that enhancers are critical to driving the expression of specific genes in specific cells where they hold important roles in maintaining health. </p>
<p>I believe that functional studies of enhancers such as the one we have conducted, combined with large-scale genetic analysis of <a href="https://www.cell.com/ajhg/pdf/S0002-9297(17)30240-9.pdf">patient data</a>, are the key to truly fulfilling the promises from that heady day in June 2000. Only then will we be able to appreciate the functional consequences of the disease-associated changes identified by previous genome studies.</p><img src="https://counter.theconversation.com/content/113325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alasdair Mackenzie receives funding from the BBSRC and Medical Research Scotland. Other academics involved in the study receive funding from the Wellcome Trust. </span></em></p>Nearly 20 years ago, Bill Clinton said that sequencing the human genome would give us a “new power to heal”.Alasdair Mackenzie, Reader, Molecular Genetics, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1095852019-01-29T14:05:26Z2019-01-29T14:05:26ZHow easy access to alcohol, and adverts, affect women in South Africa<figure><img src="https://images.theconversation.com/files/255405/original/file-20190124-135142-lwqv10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Global evidence suggests that alcohol advertisements increase adolescents’ favourable attitudes towards drinking.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Public health <a href="https://www.jsad.com/doi/abs/10.15288/jsad.2018.79.302">research</a> suggests that concerns about alcohol advertising and accessibility warrant strong regulatory action.</p>
<p>Alcohol is a major <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.12916">contributor</a> to the global burden of disease. It’s also a key risk factor for preventable illness and death in Africa. For example, alcohol <a href="http://www.scielo.org.za/scielo.php?pid=S0256-95742011001000023&script=sci_arttext&tlng=pt">consumption</a> during pregnancy is associated with many adverse effects on children. These include childhood behavioural and developmental disorders such as foetal alcohol spectrum disorders.</p>
<p>Easy access to alcohol is a critical risk factor in problem <a href="https://www.sciencedirect.com/science/article/pii/S0033350614001899">drinking</a>. This is particularly true among <a href="https://link.springer.com/article/10.1007/s10461-018-2250-y">adolescents</a>. The problem has been exacerbated on the continent by the fact that alcohol companies have <a href="http://apps.who.int/iris/bitstream/handle/10665/109914/9789290231844.pdf?sequence=1&isAllowed=y">targeted</a> young women in their marketing efforts.</p>
<p>Global evidence also suggests that alcohol advertisements increase adolescents’ favourable attitudes toward <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107550">drinking</a>. These adverts are also associated with higher <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13591">consumption</a>, as well as earlier initiation and higher intensity of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13591">drinking</a>. And recent <a href="https://www.ajol.info/index.php/samj/article/view/178644">research</a> indicates associations between exposure to alcohol advertisements and alcohol consumption among adolescents in South Africa.</p>
<p>We conducted a <a href="https://www.jsad.com/doi/abs/10.15288/jsad.2018.79.302">study</a> on the impact of access to alcohol and exposure to alcohol advertisements on women of childbearing age in rural and urban areas of South Africa. We conducted interviews with 1,018 women in one of the country’s largest cities, Tshwane, as well as in rural areas in the Western Cape.</p>
<p>Our paper found that in both urban and rural sites easy access to alcohol – as well as exposure to alcohol advertisements – were associated with significant negative social and health impacts.</p>
<h2>What we found</h2>
<p>In urban Tshwane, easy access to alcohol was related to a number of problems. These included binge drinking (defined as six or more drinks per occasion) among partners and problem drinking in the community. Complications during pregnancy were another issue. And exposure to alcohol advertisements was related to hazardous drinking in the community and inter-partner violence.</p>
<p>In rural Western Cape, easy access to alcohol was related to problem drinking among community members. It was also inversely related to families’ ability to pay for health care. For its part, exposure to alcohol advertisements was related to a number of negative outcomes. These included hazardous drinking among women and community drinking. Inter-partner violence was also a problem.</p>
<p>The slight differences between patterns in urban and rural communities were likely because of varied social and economic contexts.</p>
<p>Our findings confirm what has been found <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13682">elsewhere</a>: alcohol advertising is not a harmless brand-promoting activity. It is associated with harmful health and social outcomes. Similarly, easy access to alcohol is associated with multiple adverse health and social impacts.</p>
<p>These effects might be ameliorated by stronger laws and regulations. That’s why <a href="https://www.parliament.gov.za/storage/app/media/Docs/bill/9f8c83b4-bd7c-4dc1-af55-8d32310d64e9.pdf">amendments</a> have been proposed to the country’s National Liquor Act. Our findings support these efforts to limit access to alcohol and alcohol advertisements.</p>
<p>But South Africa has a mixed record when it comes to legislating against alcohol use.</p>
<h2>Strong industry lobby</h2>
<p>The alcohol industry has used intense lobbying <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.12832">to hold back</a> efforts to limit the availability of alcohol and alcohol advertisements.</p>
<p>For example, national legislation to ban advertising in South Africa has been <a href="https://www.businesslive.co.za/bd/national/2017-05-30-nedlac-stalls-on-tough-liquor-law-changes-without-social-cost-report/">stalled</a>. Provincial legislation in the Western Cape has been weakened by the liquor, sporting and advertising <a href="https://www.businesslive.co.za/bd/national/2017-05-30-nedlac-stalls-on-tough-liquor-law-changes-without-social-cost-report/">industries</a>.</p>
<p>The alcohol industry promotes <a href="http://gsri.worldwidebrewingalliance.org/docs/DTI_Convention_brochure_final.pdf">self-regulation</a>. But this leaves adolescents vulnerable to the harmful effects of alcohol <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13410">advertisements</a>.</p>
<p>The alcohol industry claims that it plays an indispensable role in South Africa’s <a href="http://5737034557ef5b8c02c0e46513b98f90.cdn.ilink247.com/ClientFiles/econometrix/Econometrix/Company/Documents/Economic_Impact_of_an_Ad_Ban_Econometrix.pdf">economy</a>. But public health researchers estimated that alcohol consumption cost the country <a href="https://www.ajol.info/index.php/samj/article/view/100577">approximately 10%-12%</a> of its gross domestic product in 2009.</p>
<p>Limiting alcohol advertisements and regulating the availability of alcohol are critical to ensuring the well-being of women and children in South Africa. This is particularly true because the country has the highest <a href="https://www.ajol.info/index.php/samj/article/view/89464">rates of foetal alcohol syndrome</a> in the world. These rates emerged, in part, from a system adopted in the colonial period of farmers paying workers with alcohol. The practice continued in some Western Cape farms well into the <a href="https://www.sciencedirect.com/science/article/pii/S0376871699001209">post-apartheid period</a> even though it was illegal.</p><img src="https://counter.theconversation.com/content/109585/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie London receives funding from the South African Medical Research Council, the UK Medical Research Council, the International Development Research Centre and the US Centres for Diseases Control. He is a member of the non profit advocacy organisation, the People health Movement and has consulted to the Southern African Alcohol Policy Alliance.
</span></em></p><p class="fine-print"><em><span>Neo Morojele receives funding from the South African Medical Research Council, UK Medical Research Council and the International Development Research Centre and is affiliated to the Southern African Alcohol Policy Alliance.</span></em></p><p class="fine-print"><em><span>Hanna Amanuel 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>Easy access to alcohol and exposure to alcohol advertisements affect social and health outcomes.Leslie London, Head of the Division of Public Health Medicine in the School of Public Health and Family Medicine, University of Cape TownNeo Morojele, Chief Specialist Scientist : Alcohol Tobacco and Other Drug Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.