7 Myths the Alcohol Industry Wants You to Believe

Staying on message in the liquor biz. 

“Our national drug is alcohol,” wrote William S. Burroughs. “We tend to regard the use of any other drug with special horror.” This emotional loophole in the psyche has been skillfully manipulated by the alcohol and tobacco industries ever since modern advertising was invented.

 Recently, the European Alcohol Policy Alliance, known as EuroCare, put together a brochure addressing the common messages the liquor industry attempts to drive home through its heavy spending on advertising. The messages are not just designed to sell product, but also to influence alcohol policy at the political level as well. (Eurocare is a network of more than 50 voluntary non-governmental organizations working on the prevention and reduction of alcohol-related harm in 20 European countries.) According to the group, the “industry”—the alcohol and tobacco companies—“has traditionally worked closely together, sharing information and concerns about regulation. They have used similar arguments to defend their products in order to prevent or delay restrictions being placed on them (Bond, et al. 2010).”

EuroCare offers this introduction: “The intention of this brochure is to inform professionals about the attempts made by the alcohol industry to influence alcohol policy globally and to subsequently arm them against the industry’s methods to prevent effective policies from being made…. For politicians and health experts it is important that they reveal to the public the subversive messaging of the alcohol industry and do not fall prey to the industry’s half-truths—or worse—outright lies.”

Message 1: Consuming alcohol is normal, common, healthy, and very responsible.

Explanation: To bring this message home, alcohol advertisements nearly always associate alcohol consumption with health, sportsmanship, physical beauty, romanticism, having friends and leisure activities.

I note here that it’s left to the social service agencies and non-profits to attempt to convey the opposite side of the coin: a dramatically heightened risk for health problems, traffic fatalities, domestic violence, loss of job, loss of marriage, suicide—you name it.

Message 2: The damage done by alcohol is caused by a small group of deviants who cannot handle alcohol.

Explanation: Indeed, the message of the industry is that ordinary citizens drink responsibly and that ‘bad’ citizens drink irresponsibly and are the cause of any and all problems associated with high alcohol consumption.

This one is insidious and unscientific. There is no evidence that alcoholics are “bad people,” or simply unwilling to stop engaging in bad behavior. For the industry, irresponsible drinkers are a major revenue source—the dream customer— even though alcohol manufacturers continue to insist that their advertising is primarily about driving home the message of responsible alcohol consumption and brand choice.

Message 3: Normal adult non-drinkers do not, in fact, exist.

Explanation: Only children under 16 years of age, pregnant women and motorists are recognized by the industry as non-drinkers.

My personal favorite, this one. The existence of non-drinkers is seen by the industry as a threat. Accordingly, they have subtly reinforced the message that moderate drinking is not only normal, but also good for you. Never mind that the real profits come from excessive drinking and pricing strategies that encourage it. Estimates vary, but recent studies  at UCLA show that “the top 5% of drinkers account for 42%of the nation’s total alcohol consumption.” If 5% of all drinkers account for nearly half of total alcohol sales, it would be folly for the alcohol industry to get serious about encouraging moderation. It’s not too far off the mark to say that the alcohol industry’s quarterly statements hinge on the success they have in encouraging alcoholics to believe that everything’s okay, everybody drinks that way. The message becomes clearer: Drinking is mandatory—unless you’re a deviant.

Message 4: Ignore the fact that alcohol is a harmful and addictive chemical substance (ethanol) for the body.

Explanation: The industry does not draw attention to the fact that alcohol (ethanol) is a detrimental, toxic, carcinogenic and addictive substance that is foreign to the body.

Naturally, pointing out the neuroscientific parallels between alcoholism and heroin addiction is not part of the message. Alcohol is a hard drug—ask any addiction expert. Alcoholism can kill you quick. But so far, the labeling mania that struck opponents of Big Tobacco has not played out in a major way in the battle against deceptive alcohol advertising.

Message 5: Alcohol problems can only be solved when all parties work together.

Explanation: Good, effective policies to combat alcohol consumption would require a higher excise-duty, no marketing or sponsoring, an increase in the drinking age to 18, a prohibition of the illegitimate sale of alcohol, and an increase, through a campaign, in the public’s awareness of the damages that alcohol can cause (Babor et al, 2010; WHO, 2009).

Obviously, these bullet points are not high on the alcohol industry’s agenda.

Message 6: "Alcohol marketing is not harmful. It is simply intended to assist the consumer in selecting a certain product or brand."

Explanation: Meanwhile, research has indisputably demonstrated that alcohol advertisements are both attractive to young people and stimulate their drinking behavior (Anderson et al., 2009: Science Group of the Alcohol and Health Forum; 2009). Yet the industry continues to flatly and publicly deny that advertising stimulates alcohol consumption (Bond et al; 2009).

Stuffed with attractive young people meeting and mating over alcohol, it seems fair to suggest that alcohol ads had better stimulate increased drinking, i.e., a boost in quarterly sales, or else the industry is wasting a lot of money fighting over pieces of a pie that isn’t getting any bigger. These days, slow growth is no growth.


Message 7: “Education about responsible use is the best method to protect society from alcohol problems.”

Explanation: Effective measures such as a higher alcohol excise-duty, establishing minimum prices, higher age limits and advertisement restrictions can reduce alcohol related harm and will therefore decrease the profits of the industry (Babor, 2003; Babor, 2010). The industry therefore does its best to persuade governments, politicians, and policy makers that the above mentioned measures would have no effect, are only symbolic in nature or are illegitimate.

A truly great dodge, because the strategy being advertised sounds so imminently sensible. Who could be against the promotion of responsible alcohol use? Irresponsible zealots and deviants, that’s who. Why should all of us happy drinkers be made to suffer for the sins of a few rotten apples?

Indeed, all of the messages, overtly or covertly, send the same signal: You should drink more. It’s good for you.

Photo Credit: http://www.frankwbaker.com

Moderate Drinking Doesn’t Help Your Heart

Mendelian meta-analysis and the alcohol “flush” allele.

Less than a year after the massive Mendelian randomization meta-analysis published in the British Medical Journal, a group of researchers recently wrote an editorial in the journal Addiction, which would seem to put a lid on the matter:

The foundations of the hypothesis for protective effects of low-dose alcohol have now been so undermined that in our opinion the field is due for a major repositioning of the status of moderate alcohol consumption as protective…. Health professionals should not recommend moderate alcohol consumption as a means of reducing         cardiovascular risk for patients. At the policy level, the hypothesis of health benefits from moderate drinking should no longer play a role in decision making.

To recap: In the Mendelian meta-analysis, drinkers with a genetic variant linked to the so-called alcohol flush reaction, which leads to lower consumption among those who drink, also correlated with a decreased risk of cardiovascular disease. “Carriers of the rs1229984 A-allele had lower levels of alcohol consumption and exhibited lower levels of blood pressure, inflammatory biomarkers, adiposity measures, and non-HDL cholesterol, and reduced odds of developing coronary heart disease, compared with non-carriers of this allele.”

But as it turned out, this relationship only held for drinkers, not for abstainers.

Why, then, have so many epidemiologists agreed for several decades now that “moderate” alcohol intake has a protective effect against heart diseases? According to the editorial authors—drug researchers from Australia, Canada, the U.S., and Sweden—earlier research tended to use “abstainers” as the key reference group to which drinkers were compared. Studies that separated former drinkers and occasional drinkers from abstainers got different results—they didn’t show significant protection correlating with moderate alcohol consumption. The theory, say the researchers, is that non-addicted drinkers spontaneously reduce their alcohol intake with age and medical concerns. Some of these people with a declining health profile are counted as “abstainers.” But when former and current drinkers are combined, then compared with life-long abstainers to address selection bias, “the observed disparity in health status between abstainers and low-dose drinkers was eliminated.”

But it’s not quite over. Michael Rioerecke and Jurgen Rehm at the Center for Addiction and Mental Health in Toronto, argue in another Addiction editorial that there are still a few things unaccounted for: The allele in question is assumed to be randomly spread throughout the population, which may or may not be true, especially since allele carriers are relatively rare in several European countries. The allele is also assumed to be mediated by average alcohol intake. Binge drinking, which allele carriers presuming engage in less, is not assessed in the study.  In short, they write, “we do not know if the average level of alcohol intake of the allele carriers within the strata of average consumption was indeed lower than that of the non-carriers.” Nonetheless, even Rioerecke and Rehm concede that the evidence continues to look promising for this revision of conventional drinking wisdom. More than 100 studies have shown relatively stable associations between alcohol and heart disease, and absent a new breakthrough method of epidemiological study, this one stands a good chance of holding firm.

Graphics credit: http://www.keyingredient.com/

Alcohol and Your Heart

Health benefits of moderate drinking come under fire.

One of those things that “everybody knows” about alcohol is that a drink or two per day is good for your heart. But maybe not as good for your heart as no drinks at all.

Joint first authors Michael V. Holmes of the Department of Epidemiology and Public Health at University College in London, and Caroline E. Dale at the London School of Hygiene & Tropical Medicine in London, recently published a multi-site meta-analysis of epidemiological studies centering on a common gene for alcohol metabolization. The report, published in the UK journal BMJ, brings “the hypothesized cardioprotective effect of alcohol into question,” according to the authors.

People who are born with a particular variant in the gene controlling for the expression of alcohol dehydrogenase, the major enzyme involved in converting alcohol into waste products, will show the familiar flush reaction when they drink. Alcohol, literally, can make many of them sick. This genetic variant, in combination with other enzymes, can be strongly protective against alcohol, and is much more commonly found among Asian populations. Roughly 40% of Japanese, Korean, and Northeastern Chinese populations show the characteristic “Asian glow” to one degree or another if they choose to drink.  (One reason why this effect isn't better known is that the condition is close to nonexistent in Westerners).

 People with this alcohol dehydrogenase deficiency, the researchers found, not only consume less alcohol, for obvious reasons, but “had lower, not higher, odds of developing coronary heart disease regardless of whether they were light, moderate, or heavy drinkers.”  Here are the conclusions in detail: “Carriers of the rs1229984 A-allele had lower levels of alcohol consumption and exhibited lower levels of blood pressure, inflammatory biomarkers, adiposity measures, and non-HDL cholesterol, and reduced odds of developing coronary heart disease, compared with non-carriers of this allele.”

The authors conclude that "reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.”

How does this work? The researchers aren’t completely sure, but note that the “most widely proposed mechanism” is an increase in high-density lipoprotein (HDL) cholesterol. “Although an HDL cholesterol raising effect of alcohol has been reported in experimental studies, the small sample size and short follow-up means existing studies may be prone to bias,” thereby limiting their usefulness. Moreover, the BMJ study itself found “no overall difference between allele carriers and non-carriers in HDL concentration.”

Like most meta-studies, this one has its strengths and weaknesses. The study used a large sample size, used detailed alcohol phenotypic data, and didn't have to deal with the inherent biases of observational-type studies. On the minus side, the lack of a connection between the allele in question and HDL levels is troubling, and stroke data was lacking.

But overall, the authors believe that "social pressure in heavier drinking cultures is unlikely to override the effect of the genetic variant on alcohol consumption."

In retrospect, there have been some trouble spots along the way: A 2008 study in Current Atherosclerosis Reports concluded:

In the absence of large randomized trials of moderate alcohol consumption and heart failure, we cannot exclude residual confounding or unmeasured confounding as possible explanations for the observed relationships. Thus, for patients who do not consume any alcohol, it would be premature to recommend light-to-moderate drinking as a means to lower the risk of heart failure, given the possible risk of abuse and resulting consequences.

At present, the American Heart Association does not recommend drinking any amount of wine or other alcoholic beverages in order to gain potential health benefits.


Holmes M.V.,  L. Zuccolo,  R. J. Silverwood,  Y. Guo,  Z. Ye,  D. Prieto-Merino,  A. Dehghan,  S. Trompet,  A. Wong &  A. Cavadino &  (2014). Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data, BMJ, 349 (jul10 6) g4164-g4164. DOI: http://dx.doi.org/10.1136/bmj.g4164

Photo credit: http://qsystem.gblifesciences.com/

Tripling the Tax on Alcohol

Would it do any good?

A recent article in Slate by Reihan Salam, a sort of modest proposal on behalf of a big boost in alcohol excise taxes, caught considerable flack from free market advocates and conservative bloggers last week.

Salam says Americans agree on the fact that marijuana is not as dangerous a drug as alcohol, and that this agreement offers us an opportunity to “regulate alcohol more stringently than we regulate marijuana.” In fact, Salam argues, why not push the envelope: “Raise the alcohol tax to a point just shy of where large numbers of people will start making moonshine in their bathtubs.”

Salam tries to head off some of the usual criticisms by noting that Prohibition was an unmitigated disaster, but that “what most of us forget is that the movement for Prohibition arose because alcohol abuse actually was destroying American society in the first decades of the 20th Century," and that companies like Anheuser Busch and MillerCoors are plotting with national retail chains as you read this, scheming to make alcohol as cheap and easy to buy as humanly possible.

Salam further justifies a tripling of alcohol taxes by viewing it as a tactical offset to the efforts of liquor companies to focus on their best customers: “the small minority of people who drink the most.” Salam says that right now, it costs about two bucks per inebriated hour to get your drink on. Can we really argue that this price level is just too unsustainably high? Drug expert Mark Kleiman, Professor of Public Policy at UCLA, agrees.  In his book Marijuana Legalization: What Everyone Needs to Know, Kleiman and co-authors argue that “tripling the tax would raise the price of a drink by 20 percent and reduce the volume of drinking in about the same proportion. Most of the reduced drinking would come from heavy drinkers, both because they dominate the market in volume terms and because their consumption is more price-sensitive…."

Minnesota legislators recently passed a bill that opponents say would increase state excise taxes on alcoholic beverages to six times the current levels. Supporters of the alcohol tax say it means an extra $200 million per year to the state, at a cost to drinkers of about seven cents per drink. Or, in Salam's example: “Charging two-drink-per-day drinkers an extra $12 per month seems like a laughably small price to pay to deter binge drinking…. If you’re going to tax tanning beds and sugary soft drinks, why on earth wouldn’t you raise alcohol taxes too?”

Why wouldn’t you? Because it doesn’t accomplish what you want to accomplish, writes Michelle Minton at openmarket.org, the blog of the Competitive Enterprise Institute.  After a bit of throat clearing about the Nanny State, Minton writes that “fortunately, a society’s relationship with alcohol isn’t based solely on the price of alcohol…. Research shows that alcohol price is not an effective means of achieving lower total consumption or reducing binge drinking.” As evidence, Minton points to studies showing that Luxembourg and the Czech Republic “have both the highest priced alcohol and the highest rates of consumption in Europe.”

As for a comparison favored by Salam—New York’s anti-smoking campaign—Minton admits that the new higher cost of cigarettes cut the adult smoking rate dramatically, but points out that “New York is now the number-one market for smuggled cigarettes—which account for more than half of all cigarettes smoked in the state.” This is a powerful argument. If we triple the taxes on alcohol, do we risk a black market of dangerous home-brew bootlegger booze?

In my view, such threats are real, but they are theoretical. The current costs of alcohol in socioeconomic terms are enormous and undeniable. Tripling the alcohol tax might be asking for trouble, but we could get there in stages if Americans saw it as a desirable goal. Arguments against tax increases tend to ignore the fact that alcohol is a different kind of product, capable of addicting a significant minority of users, in addition to killing a certain percentage of drinkers outright through alcohol poisoning and traffic accidents. If we ignore the issue of drug dependence, and the health and legal costs of assorted alcohol-related mayhem, and simply lean on the fact that most people who drink use alcohol responsibly, then it gets easier to argue against increases in alcohol and cigarette taxes. Alcohol is not like other household products, and needn't be regulated like them.

Dr. David Nutt on Alcohol

Rebutting industry myths.

A couple of years ago, the European Alcohol Policy Alliance, known as EuroCare, put together a brochure addressing the common messages the liquor industry attempts to drive home through its heavy spending on advertising. The messages are not just designed to sell product, but also to influence alcohol policy at the political level. According to EuroCare, the “industry”—the alcohol and tobacco companies—“has traditionally worked closely together, sharing information and concerns about regulation. They have used similar arguments to defend their products in order to prevent or delay restrictions being placed on them.”

I wrote a blog post on EuroCare’s list of alcohol untruths called “7 Myths the Alcohol Industry Wants You to Believe." Here they are:

Message 1: Consuming alcohol is normal, common, healthy, and very responsible.

Message 2: The damage done by alcohol is caused by a small group of deviants who cannot handle alcohol.

Message 3: Normal adult non-drinkers do not, in fact, exist

Message 4: Ignore the fact that alcohol is a harmful and addictive chemical substance (ethanol) for the body.

Message 5: Alcohol problems can only be solved when all parties work together.

Message 6: Alcohol marketing is not harmful. It is simply intended to assist the consumer in selecting a certain product or brand.

Message 7: Education about responsible use is the best method to protect society from alcohol problems.

Recently, I ran across a great response to these same 7 myths by Dr. David Nutt, the British psychiatrist perhaps best known in the states as the scientist who got fired a few years ago from his post on the government’s Advisory Council on the Misuse of Drugs. Nutt’s primary sin was to suggest that, on a straightforward calculation of risks and harms, horseback riding was probably a more dangerous activity than taking the drug Ecstasy. The Home Secretary at the time insisted that you couldn’t compare a legal activity to an illegal one, or something like that, and Nutt compounded his sins by suggesting that marijuana was a safer drug than alcohol. British politicians took a serious dislike to him, the more so since most of the published medical science was on his side. After the dust settled, Nutt was one of the primary founders of the Independent Scientific Committee on Drugs (ISCD), formed to offer alternative views on drugs and addiction grounded in science.

Anyway, in his book, Drugs Without the Hot Air, Nutt has his own responses to the 7 Myths, which I excerpt here:

1. Consuming Alcohol is Normal: It’s normal, so long as you have the “normal” high-activity variant of the ALDH2 enzyme. If you don’t have that form of the enzyme, Nutt reminds his readers, as many Asians and Aleuts do not, then alcohol will affect you quite non-normally through the so-called alcohol flush reaction. Moreover, many cultures and societies unfamiliar with its effects “suffer hugely when new types of alcohol appear, particularly if they are aggressively marketed.”

2. Alcohol damage is caused by a small group of deviants: According to Dr. Nutt, statistics show that “millions of people, NOT a tiny minority, suffer harm from their own alcohol consumption, or cause harm to others…. It is the everyday drinking of people who have come to see alcohol as an essential part of life rather than the luxury it used to be, that has created a spike in cancers and stomach problems, and will see liver disease match heart disease as the leading cause of death in the UK by 2020.”

3. Normal adult non-drinkers do not exist: The alcohol industry is forever reminding politicians of how unpopular alcohol restrictions are to the voting populace. “The existence of non-drinkers obviously threatens this portrayal of society, so the industry tends to dismiss them as having something wrong with them. While some teetotalers are recovering alcoholics, many others have made a positive choice not to drink.” And there are others, I would add, often referred to as “sick” teetotalers, who have quit drinking for medical reasons unrelated to alcoholism.

4. Ignore alcohol’s harm to the body: Nutt reminds us that “there is no other drug which is so damaging to so many different organ systems in the body…. Most other drugs cause damage primarily in one or two areas—heart problems from cocaine, or urinary tract problems from ketamine. Alcohol is harmful almost everywhere.”

5. Alcohol problems can be solved when everybody works together: “In practice, what the industry means by ‘working together’ is bring in voluntary codes rather than statutory regulation—solving problems through rules that the industry CHOOSES to comply with, rather than laws which they MUST comply with.”

6. Alcohol marketing is intended to assist consumers in selecting products: Specifically, 800 million British pounds every year for advertising and promotion, according to Nutt. That’s just the kind of civic-minded bunch those alcohol sellers are. The reality, of course is that “marketing communications do have a marked effect on consumption…. All this further entrenches the false division between alcohol and illegal drugs, persuades people that consuming alcohol is safe, and makes realistic discussions of the harm alcohol causes very difficult.”

7. Education about responsible use is the best approach: “It is useful for the drinks industry,” Nutt explains, “to emphasize the value of education, because it takes the focus off regulation…. There is also extensive evidence gathered by the WHO from around the world, showing that merely providing information and education without bringing in other policy measures doesn’t change people’s drinking behavior.”

As I wrote in my original post: Who could be against the promotion of responsible alcohol use? Irresponsible zealots and deviants, that’s who. Why should all of us happy drinkers be made to suffer for the sins of a few rotten apples?

Indeed, all of the messages, overtly or covertly, send the same signal: You should drink more. It’s good for you.

Graphics Credit: http://www.holyrood.com/2011/04/at-what-price/

The Truth About Weight Loss Surgery and Alcohol

Bariatrics and booze don’t always mix.

For many people with obesity, bariatric surgery has proven to be a lifesaver. But for a subset of post-operative patients, the price for losing five pounds every time you step on the scale turns out to be an increased appetite for alcohol.

In a study of almost 2,000 patients who underwent surgery for severe obesity, the patients had either gastric bypass surgery (RYGB) in which a portion of the stomach and small intestine are removed, or gastric banding, a process by which an adjustable “lap band” is tightened around the entrance to the stomach. Those who opted for gastric bypass showed an increase in alcohol consumption two years after surgery, according to a recent study by Wendy C. King and coworkers in the Journal of the American Medical Association.

The notion that weight loss surgery, known as bariatric surgery, was related to increased use of alcohol had been an anecdotal staple among patients with obesity for years. Oprah Winfrey based one of her daytime television shows on the rumor back in 2006. Dr. King and a diverse group of associates concluded last month at the American Society for Metabolic and Bariatric Surgery annual meeting that “a significantly higher prevalence of alcohol use disorder” was associated with the second year following gastric bypass surgery. (During the first postoperative year, patients are strongly advised not to drink at all.)

Moreover, some of the patients who showed high-risk alcohol intake had not been problem drinkers before surgery. Some had not been drinkers at all. But the effects of gastric bypass, coupled with permission to drink a year after surgery, lead to an increase in alcohol abuse and alcoholism. While the overall increase was relatively modest, patients who had gastric bypass surgery were twice as likely to drink heavily than patients who underwent the lap band procedure.

“It’s a great study,” says Dr. Stephanie Sogg, staff psychologist at the Massachusetts General Hospital Weight Center and assistant professor in the Department of Psychiatry at Harvard Medical School, who was not associated with the study group. In an interview for this article, Sogg called the distinction between surgeries “an extremely important finding. They saw changes in alcohol use patterns with gastric bypass, but not with gastric banding. That’s exactly what we would expect.”

The findings make biochemical sense: “Gastric bypass surgery bypasses a part of the stomach that secretes alcohol dehydrogenase,”—a primary enzyme of alcohol metabolization, says Sogg. “And in gastric bypass, the alcohol is not coming into contact with the first part of the intestine, the duodenum. That’s going to cause some changes in the way the body processes alcohol that aren’t true of gastric banding. If this were a case of people who are addicted to food having to change their eating and thus becoming addicted to alcohol, we would expect to see the same changes whether the person had gastric bypass or gastric banding.”

It would be natural to assume that people with prior drinking problems would have the most trouble with alcohol control postoperatively. But things are rarely that simple in medicine. “Previous alcohol history sets up people for risk of relapse, but there’s a significant subset of people having trouble with alcohol who never drank at all,” says Dr. Sogg. “That’s where the real story is.”

Dr. David B. Sarwer, associate professor of psychology and director of clinical services for the Center for Weight and Eating Disorders at the University of Pennsylvania, called the King study “the most definitive evidence to date on the prevalence of alcohol use disorders in persons who undergo bariatric surgery.” In an email exchange, Sarwer said: “Individuals with a history of alcohol or substance abuse are informed that the stress of the dietary and behavioral requirements of bariatric surgery, like all major life stressors, could threaten their sobriety or abstinence. However, we simply do not know enough about the use of alcohol and other substances after surgery to predict this with a great degree of certainty.”

Dr. Sogg agrees. For the bariatric surgery population, the pharmacokinetics of alcohol changes. They become more sensitized to its effects—a little now goes a long way. The main problem, she says, is that “we’re not good yet at predicting exactly whom it’s going to happen to.”

But she has some thoughts about vulnerable subsets. “Some people with obesity have poor coping skills,” she says. “And now alcohol is so much more potent and reinforcing for them that alcohol becomes the coping strategy. When this biological change with alcohol happens, they may be the ones who are at higher risk of responding to that change by developing problems with alcohol.”

Warning patients about alcohol risks of weigh-loss surgery is becoming more common, says Dr. Sogg. “It doesn't change my decision-making about whether somebody should or shouldn't have surgery. But we can evaluate people's coping skills before surgery and point out to them that it is important for them to develop other ways of dealing with negative emotions besides eating." 

She also thinks that “people who have a history of actually becoming abstinent after drug or alcohol dependence may be better equipped for surgery. They will be less likely to put themselves in the path of alcohol use, and they have experience at making major successful long-term behavior changes. Basically, we should not consider past encounters with substance abuse as contraindications for surgery. But we should be carefully evaluating whether people are currently using substances at the time of surgery.”

In the end, she said, “I tell every one of my patients before surgery that they need to be aware of the risks of problem drinking after surgery, monitor their alcohol intake, and come back to us immediately at the first sign of any concerns about their drinking.”

King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, Courcoulas AP, Pories WJ, & Yanovski SZ (2012). Prevalence of Alcohol Use Disorders Before and After Bariatric SurgeryAlcohol Use Disorders and Bariatric Surgery. JAMA : the journal of the American Medical Association, 1-10 PMID: 22710289

 Photo credit: http://www.treatment4addiction.com/

Diurnal Drinking

Casting a light on circadian disruptions.

Scientists and laypeople alike have known for years that the consumption of alcohol interferes with the body’s biological ability to synchronize its daily activities with light. Disruptions of the body clock due to alcohol increase the risk of cancer, depression, and other health problems. Furthermore, a recent animal study showed that the effect of alcohol on sleeping patterns could be detected several days after the last drinking event.

Alcohol’s chronobiological effects grow more profound as steady consumption continues. Previous research has demonstrated the disruptive function of alcohol on melatonin rhythms, body temperature and glucocorticoid release.  Disturbingly, recent research suggests that such disruptions along the hypothalamic-pituitary-adrenal axis may predispose alcoholics to relapse—a vicious hormonal feedback cycle. In a study on hamsters published in the American Journal of Physiology, researchers at Kent State University and the University of Tennessee describe “a feedback cycle of circadian rhythm deterioration and reinforcing alcohol self administration” mediated by glutamate and NMDA-driven “phase resetting of the circadian clock.”

The study separated drinking from non-drinking hamsters, and subjected both groups to light exposure in order to break up the regular diurnal wake/sleep cycle of the animals.  Hamsters that drank only water during the test woke up 72 minutes earlier than normal, while hamsters drinking 20% alcohol did not reset their internal clocks as acutely, waking up only 18 minutes earlier.

However, as Christine Guilfoy wrote for Medical News Today, “When the hamsters were withdrawn from alcohol for 2-3 days and then exposed to the same light treatment again, they woke up much earlier than the animals that had drunk only water. The hamsters that were withdrawn from alcohol woke up 126 minutes sooner compared to the water drinking control group, which advanced 66 minutes. This exaggerated response persisted even up to three days later, when the experiment ended.”

Bearing in mind that drawing conclusions about human brain behavior from animal studies is unavoidably speculative, what possibilities emerge from this study? From the short-term perspective, the researchers note that people who drink alcohol late at night are probably less likely to respond appropriately to light cues, and therefore less likely to keep their biological clocks synchronized over the next 24 hours. Moreover, this circadian disruption from drinking may continue for several days, like jet lag, even after a complete abstention from alcohol.

The researchers also discovered that the drinking animals had fewer bouts of activity during normally active hours, leading to the suggestions that heavy drinkers may be less active during normally active daytime hours, and more active late at night, when chronobiological systems are signaling for sleep. The result: chronic daytime sleepiness.

The major point of the study may be that “brain systems involved with circadian regulation are closely and reciprocally tied to those underlying alcohol abuse,” and that this connection has been underscored “by recent studies showing a link between circadian clock genes and an increased drive for alcohol consumption.”

The Low Cost of Drinking

Does cheap liquor encourage excess?

Last year, Sir Liam Donaldson, the Chief Medical Officer in England, touched off a storm of controversy with his call for a government-mandated minimum pricing schedule for the sale of alcohol.

Donaldson’s pricing plan would set a minimum of 50p per unit of alcohol, or roughly 80 cents. This floor on alcohol pricing would mean that a bottle of wine could not be sold for less than $7.20, a bottle of whisky for less than $22, or a six-pack for less than about $9.50. Such a measure would effectively double the price of the cheapest alcohol sold in some discount supermarkets.  Sir Liam Donaldson and other health officials have pointed out that, while alcohol consumption in many European countries has fallen since 1970, consumption in England has increased by 40%.

 Sir Liam estimated that the pricing minimums would save more than 3,000 lives and result in 100,000 fewer hospital admissions per year.

Further roiling the waters was a London Times article in December titled “Alcohol now costs less than water.” The Times found that cut-price deals at British supermarkets were endemic. Don Shenker, chief executive of Alcohol Concern, said that supermarket discounting was undermining the government’s efforts to curb binge drinking in the UK: “The evidence shows young people and harmful drinkers are drawn to very cheap alcohol.” The British Medical Association also threw its support behind a crackdown on deeply discounted alcohol sales.

However, Prime Minister Brown announced his government’s opposition to minimum pricing, arguing that the proposal would penalize the majority of sensible drinkers due to the actions of a few. It was also suggested that the measure might be illegal under EU competition laws.

As it turned out, alcohol was only cheaper than water if you bought the most expensive water and the least expensive booze. But no matter—the point had been made. “We have a huge problem with alcohol abuse in the UK,” said a spokesperson for the British Medical Association, “so we want a clampdown on these cut-throat price deals.”

Scotland also announced it was considering a minimum pricing plan. However, a study by Deloitte Research, reported in the Herald Scotland, found that only one out of five adults would be likely to buy less alcohol under a minimum price system.  52% said they would spend more money for the same amount of alcohol or else seek out cheaper brands.  In addition, the Deloitte research suggested that people use cheap supermarket alcohol for “pre-fueling” or “pre-loading” before going out for the night.  Scotland’s alcohol intake per person is higher than Britain’s. Recently, the Scottish government released a report from the University of York, which estimated that alcohol abuse cost Scottish taxpayers almost $7.5 billion a year.

British Health Secretary Andy Burnham told the UK Telegraph that while he did not wish to “punish the majority of people who drink responsibly,” he maintained there was no argument about “the link with price and people drinking harmful levels of alcohol—there is no debate about that.” Government officials note that the imposition of some form of levy might be required to keep the drinks industry from reaping windfall profits from a price increase. To date, the British Cabinet has taken no formal action on the matter.

Starting in April, British pubs and clubs will be banned from running “all you can drink” nights and other “irresponsible drink promotions,” according to The Independent. The plans have met with stiff opposition from pub owners, the alcohol industry, and the public.

All of this may be in vain: The demand for alcohol, in economic terms, may be highly inelastic, like the demand for cigarettes and coffee. Price hikes for those two items over the years have not been accompanied by similar declines in usage.

Photo Credit: www.design4retail.co.uk

Mixing up the Medicine: What Alcohol Doesn’t Go With

Drug/Drink interactions are no joke. 

--Mixing alcohol with certain antibiotics, like Furozone and Flagyl, can lead to headache, nausea, vomiting, and even convulsions.

--Chronic alcohol consumption increases the risk of liver damage from surgical anesthetics like Ethrane and Fluothane.

--Alcohol decreases the effectiveness of Inderal, a common medication used to control blood pressure.

--Continued high levels of alcohol activate the enzymes that metabolize Tylenol and other forms of acetaminophen into compounds that can impair the functions of the liver.  In older persons, the combination markedly increases the risk of gastric bleeding.

Get your exercise, eat your vegetables—and don’t mix alcohol with a list of common medications about as long as your arm. Unfortunate but true. But let’s face it—people cut corners on this matter all the time. People like to drink.  With 70 percent of the adult population consuming alcohol at least occasionally, and more than 10 percent consuming it on a daily basis, the 14 billion prescriptions doctors write annually, accounting for more than 2,800 prescription drugs (plus another 2,000 over-the-counter medications) means that the “concurrent use” of booze and pills is inevitable (figures from NIAAA).

But it’s my job to be the wet blanket, and soldier on, and present my readers with a list of common drugs, which, if any of my readers are taking them regularly, means they should not be getting their drink on.

What is actually going on when alcohol and prescription drugs interact? The amount of drug that reaches its site of action is known as its availability. Alcohol can have a direct effect on a drug’s availability and hence its effectiveness. Alcohol in acute doses—a drink now and then, or a few drinks over several hours—can increase a drug’s availability by competing for the same set of enzymes of metabolization. This increases the chances of harmful side effects. Alcohol in chronic doses—long-term heavy drinking—can have the opposite effect, decreasing a drug’s availability and effectiveness by activating metabolizing enzymes, even in the absence of alcohol.

I have edited the list to eliminate low-risk, trivial, or commonly understood interactions. Most people, for example, know that drinking seriously on top of prescription sedatives, opiates and other painkillers, or anti-anxiety medications like Xanax and Valium, is universally understood to be a risky venture. That particular combination is how lots of people stop breathing, permanently.

Having glossed those categories, we move on to a blizzard of other restrictions for daily drinkers, some very serious, some less so. They have been culled from the University of Rochester’s excellent University Health Service site,  and from publications available at the website for the National Institute on Alcohol Abuse and Alcoholism (NIAAA). An extensive list of references can be found at NIAAA’s Alcohol Alert.

--Other antibiotics  that may be responsible for adverse effects, according to the NIAAA, includes Acrodantin, Flagyl, Grisactin, Nizoral, Nydrazid, Seromycin, and Tindamax (all trade names).

--Cardiovascular medication that can cause possible problems if combined regularly with alcohol include Coumadin and Nitroglycerin which may become less effective, while blood pressure meds like Catapres, Lopressor, Accupril, and several others may lead to dizziness and fainting.  The NIAAA also notes potential reductions in the therapeutic effects of reserpine, methyldopa, hydralizine, and guanethidine.

--Allergies/cold medications react with alcohol in the usual way—increased drowsiness, and possible dizziness, particularly in the elderly. Drugs containing diphenhydramine, like Benadryl, or chlorpheniramine, like Tylenol Cold and Flu, can prove substantially more sedating with alcohol.

--The anti-ulcer medications Tagamet and Zantac “increase the availability of a low dose of alcohol under some circumstances.”

--Thorazine, a common antipsychotic, can lead to “fatal breathing difficulties” when combined with alcohol, according to the NIAAA.

--The anti-seizure drug Dilantin may not control epileptic seizures as effectively in chronic drinkers.

There are others, too many to list here. But if you are a chronic drinker—and you know who you are—don’t be so quick to dismiss the variously-worded DO NOT MIX WITH ALCOHOL warnings if you find them on your pill bottles.

Photo Credit:  http://www.doitnow.org/

Choline for Fetal Alcohol Spectrum Disorders?

Common supplement may reduce cell death in pregnancies.

A common dietary supplement markedly decreases defects in the skull and brain formation of  lab mice born to mothers exposed to alcohol, say researchers at the Medical College of Georgia.

Among the grisly list of potential effects caused by alcohol consumption during pregnancy, one involves a relatively obscure lipid called ceramide. Ceramide can markedly increase the rate of programmed cell death—a process known as apoptosis—and may be involved in the characteristic cranial defects seen in fetal alcohol syndrome.

In the study, 25 % of the mouse embryos exposed to alcohol showed characteristic defects in skull development, including diminished growth in the multi-layered membrane—the meninges--covering the brain.  Biochemists Erhard Bieberich and Guanghu Wang, in an article published in Cell Death and Disease, found that the supplement CDP-choline decreased cell death and protected the fetal cranium from damage due to maternal drinking episodes. According to Dr. Bierberich in a press release from the Medical College of Georgia, the result of alcohol on pregnancy is “a snowball effect. The neural crest is damaged, the meninges doesn’t develop properly and tissue like bone and brain that are regulated by the meninges don’t develop properly either.”

Choline is a precursor to the neurotransmitter acetylcholine. In addition, it has been known for decades that alcohol increases choline requirements. Choline is already added to some baby formulas and prenatal vitamins. Choline’s effects on stroke and traumatic brain injury are also being investigated.

A similar discovery twenty years ago concerning folic acid led the U.S. Public Health Service (USPHS) to recommend that all women thinking of becoming pregnant should consume supplemental folic acid daily in order to reduce their risk of having a pregnancy affected by spina bifida or other neural tube defects. The rate of occurrence of this kind of birth defect has been dropping ever since.

The researchers believe that “there is just a little window” four weeks after conception—while neural cells are forming numerous organs--when the alcohol-related cranial damage is likely to occur. Unfortunately, this window of disaster opens before many women have discovered that they are pregnant. 

Since warnings about the dangers of drinking during pregnancy are either not known or are ignored in many cases, researchers are always on the lookout for medications that could be given after exposure to alcohol--or even after birth of a baby to an alcoholic mother.  As early as 2005, researchers at Tripler Army Medical Center in Honolulu demonstrated that adding choline to the pre-natal diet of pregnant alcoholic rats suppressed physiological symptoms of fetal alcohol syndrome in the offspring. In a press release from the American Physiological Society, lead researcher John Claybaugh asserted that the results “are consistent with the hypothesis that supplemental dietary choline fed to the pregnant dam can prevent the alcohol-induced partial diabetes insipidus seen in the young adult offspring.”

The American Psychological Association, in the wake of a 2007 study published in Behavioral Neuroscience, announced that “giving choline to infants who were exposed in the womb to alcohol may mitigate some of the resulting problems” related to learning, attention, and motor skills. The researchers gave choline to rat pups exposed to alcohol during the third trimester. Alcohol-related hyperactivity and learning deficits decreased, the researchers say. “The data suggest that early dietary interventions may reduce the severity of some fetal alcohol effects, even when administered after birth."

 Despite such optimism, the issue is whether a choline supplement would be capable of rescuing cells after alcohol exposure, or whether choline would need to be taken ahead of time as a supplement.

What is not at issue is that pregnant women should not drink, and should be aware that fetal damage can occur very early in a pregnancy.

Graphics Credit: http://www.cholineinfo.org/

Wang, G., & Bieberich, E. (2010). Prenatal alcohol exposure triggers ceramide-induced apoptosis in neural crest-derived tissues concurrent with defective cranial development Cell Death and Disease, 1 (5) DOI: 10.1038/cddis.2010.22

Cancer and Women Who Drink: A Flawed Study?

Taking a second look at the numbers.

Last week’s front page Washington Post story on the increased risk of cancer among women who drink shed more heat than light on the underlying conundrum: Are a few drinks good for you, or aren’t they?

A British study involving almost one and a quarter million women—a huge survey by any standards—found that just one drink of alcohol per day increased the statistical risk of contracting cancer. According to the Post story by Rob Stein, as little as 10 grams of alcohol a day elevated women’s risk for cancer of the breast, liver, and rectum in particular. “Based on the findings, the researchers estimated that about 5 percent of all cancers diagnosed in women each year in the United States are the result of low to moderate alcohol consumption,” the Post reported. “Most are breast cancers, with drinking accounting for 11 percent of cases—about 20,000 extra cases each year—the researchers estimated.”

But wait a minute. Wasn’t it just yesterday that researchers were confirming and reconfirming that a couple of drinks a day was good for your heart? Presumably, this included women’s hearts as well. What’s going on?

For starters, the conclusions of the study itself, published in the Journal of the National Cancer Institute, have some problems. In an article entitled, “Women: How Bad is a Regular Nip?” Janet Raloff writes in the Web edition of Science News that female participants were queried only about weekly alcohol consumption. To arrive at figures for daily intake, the researchers divided by seven. “However,” writes Raloff, “if someone averages seven drinks a week, those beverages might have been downed on weekends only—leading to consumption of three or more drinks at a sitting. That would be bad even for the heart. Also, in the long haul, for anyone’s liver.” Unless we know about daily drinking, the study “only offers fodder for speculation.”

There are other problems. As it turns out, nondrinkers have an elevated risk for certain kinds of cancers. Study author Naomi Allen and coworkers at the University of Oxford write that alcohol apparently confers some sort of protective effect when it comes to cancers of the pharynx, esophagus, stomach, cervix, and other sites.

In addition, Raloff, points out, “There’s the impact of smoking.” Some of the alcohol-linked cases of cancer in women—esophagus, liver, and larynx, for example—increased only among those women in the study who also smoked.

Specifically, Raloff recommends that women with a genetic predisposition for breast cancer might decide that “no alcohol is the best policy.” And for people at low risk for heart disease, it’s difficult to justify drinking because it’s good for your heart. However, “study after study has offered quantitative evidence that middle-age and older adults who take a regular nip—like that proverbial glass of sherry after dinner or at bedtime—suffer less heart disease and diabetes than teetotalers or people who consume more than two drinks a day.”

And that, at present, is where the matter still stands. As Raloff sensibly concludes, “Let’s not scare people with incomplete data. There will be plenty of time to hammer home a call for temperance if and when stronger data emerge.”

Photo Credit: www.injuryboard.com

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Alcoholic Deception

Big Alcohol Wants a Piece of the Health Market

For a long time now, snack food companies have been spending billions to convince shoppers that their fattening food offerings are fit and healthy nutrition alternatives. Big Alcohol, which has played around the edges of all this with “lifestyle” beer commercials, has been pushing into the health business more steadily of late, as opportunities for advertising shrink. The Marin Institute, which has got to be Big Alcohol’s least favorite advocacy group in the world, just released its new study: “Questionable Health Claims by Alcohol Companies: From Protein Vodka to Weight-Loss Beer.” The group documents the many ways in which alcoholic beverage makers are seeking to emulate food corporations in staking a misleading claim to words like “natural” and “organic.”

“The wine industry has been exaggerating wine’s health benefits for years. Now Big Alcohol is taking such messages to a whole new level,” said Marin Institute’s Research and Policy Director Michele Simon, one of the report’s authors. “Major alcohol companies are exploiting ineffective or non-existent regulatory oversight,” she added.

The Marin Institute breaks down Big Alcohol’s advertising assault into three areas of concern: adding nutrients, using the term “natural,” and using alcoholic beverages in fitness-themed promotional campaigns. It’s a free country, more or less, and there’s no point being a prude about these things. But a deeper look at alcohol advertising strategy can be enlightening. As the Marin Institute admits, alcohol’s advertising strategies “may seem relatively harmless.” but when it comes to promoting sales, the consequences are “potentially dangerous.” And overlapping regulatory agencies don’t make it any easier. Technically, the U.S. Alcohol and Tobacco Tax and Trade Bureau (TTB) is in charge of regulating alcoholic beverages, but the U.S. Federal Trade Commission has control over alcohol advertising, and determines whether it is unfair, false, or deceptive.

Here is a portion of the Marin Institute’s list of unsupported health claims:

--Fortified vodkas. Fortified foods have been around forever, but it wasn’t until 2007 that the first fortified vodka hit the market. Lotus White, infused with added B vitamins, “could actually be good for you,” said the company’s CEO. The Federal Trade Commission (FTC) prohibited Lotus from advertising the B vitamins on its packaging, so CEO Bob Bailey told the press that Lotus White provided drinkers with 100% of their daily recommended intake of B vitamins. “Alcohol is bad for you,” he told the press, according to the Marin Institute report. “Ours is just slightly less bad.” The report says that retailers in Los Angeles advertise Lotus as a “Vitamin B Enhanced Super Premium Vodka.” However, since alcohol is known to inhibit the absorption of nutrients like Vitamin B1 and B12, and folic acid, Dr. R. Curtis Ellison at the Boston University Medical School says that putting B12 in alcohol is “like putting vitamins in cigarettes.” Nonetheless, sales of Lotus vodka shot up 50% in 2009, says the Marin Institute, before the company went out of business last year. In November of 2009, along came Devotion, billed as the world first “protein-infused ultra premium” vodka. Sounds more like shampoo than a shot of vodka, but adding “protein” is now another marketing angle. The problem is that these approaches appear to fail the basic health rules of the regulatory agencies, to wit, that such claims must be “substantiated by medical research.” Try this one: Fragoli, introduced three years ago, a red liquid with a little red strawberry at the top of the bottle. “Forbidden Fruit,” has been one of the company taglines. And a company press release put it this way: “In a recent scientific study, researchers found that the addition of ethanol—the type of alcohol found in most spirits—boosts the antioxidant nutrients in strawberries and blackberries.” As the Marin Institute pointed out: “While the study they referenced did find that ethanol increased antioxidant levels in berries Fragoli implies that drinking cocktails is one way for people to get those antioxidants, which the study does not conclude.”

--All-natural spirits. Flavored vodkas have been with us for decades. But the competition is brutal. By 2008, there were at least 120 flavored vodka products on the market. The Marin Institute found that in that year, “three of the five top-selling vodka companies in the U.S. had ad campaigns with fruit and positioned their products as fresh or all-natural: Absolute (2nd), Skyy (4th), and Stoli (5th). Skyy was advising drinkers to “Go Natural,” with “100% real fruit and premium Skyy vodka,” as well as its line of “all-natural infusions.” Notably, the words “infusion” and “all-natural” remain undefined by the TTB. Similarly, Blue Ice vodka was among the 84 “organic” alcohol products that came on the market between January, 2008 and October, 2009. My particular favorite is Blue Ice Organic Wheat—certified organic by the U.S. Department of Agriculture (USDA), in a classic case of federal agencies in conflict. 

--Fitness campaigns. Miller Lite, the “healthy” beer that started it all, launched in 1973, and ever since, commercial viewers have been subject to an endless collage of young people running, dancing, and diving into crystal streams. But it was not until the diet-conscious new century that sales of light beer exploded along with low carb diets. In 2004, Great Britain went after Michelob Ultra for its “lose the carbs, not the taste,” advertising, on the grounds that the campaign implied that beer drinking was part of a healthy lifestyle. No matter; Michelob went on to sponsor the UK Olympic teams in 2006 and 2008. By 2009, Michelob Ultra had no qualms about advertising itself as “a smart choice for adult consumers living an active lifestyle.” The Marin Institute has always been particularly rankled by the mainstay of beer advertising—sponsored sporting events. When Michelob signed a three-year deal with Lance Armstrong, the Marin Institute howled, because “the advertising campaign mixed images of Armstrong exercising and consuming beer while in the context of this activity,” another violation of the advertising rules concerning alcohol consumption and health. “Probably the most blatantly illegal advertisement came in early 2009,” says the Institute’s report, “when a new beer called MGD 64 (boasting just 64 calories) sponsored an online fitness program in association with Shape and Men’s Fitness magazines.” Again, the authors argue that if FTC and TTB standards don’t apply to alcohol-sponsored weight loss programs, then what DO they cover?

If you put it all together, “such marketing represents a significant failure in the regulatory oversight of alcohol advertising.” Small wonder, since regulatory oversight is split across two or three federal agencies, 50 state beverage control agencies, and state attorneys general. Plenty of regulating to go around, if it was more sensibly deployed. But if it were, protein vodka would probably not be on the market. The Marin Institute’s modest proposal is to transfer jurisdiction over the regulation of alcohol advertising practices to the Food and Drug Administration (FDA), to which Congress recently granted greater powers of regulation for cigarette products. Once again, the institutional confusion and inertia caused by the artificial distinction between “legal” and “illegal” drugs is hampering efforts to effectively regulate the sale of this addictive drug.

Graphics Credit: http://www.marininstitute.org/site/

Dude, where’s my metaconsciousness?

“Lost in the sauce.”

I have to admit I was taken with the opening sentence of this 2009 study published in Psychological Sciences: “Alcohol consumption alters consciousness in ways that make drinking both alluring and hazardous.”

Indeed it does. There’s no improving on that direct statement about the basic paradox presented by booze: Like so many pleasures, it is both seductive and dangerous. I was further intrigued by the prospects held out by the abstract, which promised “a rigorous examination of the effects of alcohol on experiential consciousness and metaconsciousness.” After all, we have come a long ways from the 50s, when alcohol was seen in Freudian terms, as a way of releasing tension, steam-engine style.

The study, by Michael A. Sayette and Erik D. Reichle of the University of Pittsburgh in Santa Barbara, along with Jonathan Schooler of the University of California at Santa Barbara, walks us through the salient recent theories, including the alcohol-myopia theory that gained a foothold in the 90s. In this theory, alcohol “reduces processing capacity so that a great proportion of this capacity has to be devoted to the demands of immediate, ongoing activity.” Like remaining upright, or inserting a key in the lock of a door. It also means that alcohol consciousness is precarious. The pissed-off office worker who comes home to drink may relieve his worries “if he is distracted by television, but he may ‘cry in his beer’ if no such distraction is available.”

One of the alluring and hazardous affects of alcohol is its tendency to cause what the study authors meticulously refer to scientifically as: zoning out. That is to say, episodes of mind wandering.

Enjoy drinking while you read? Listen to this: “Participants who drank alcohol were mind-wandering without awareness of doing so about 25% of the time that they were engaged in the reading task. This frequency was more than double that for participants in the placebo condition.”

The study—“Lost in the Sauce: The Effects of Alcohol on Mind Wandering?”—investigated “the effect of alcohol on both the occurrence of mind wandering and the capacity to notice that one’s mind has wandered.” The psychologists gathered 50 men between 21 and 35, put them in a lab, and then split them into a control group and test group. The participants entered the “drink-mixing room where a research was waiting with a tray containing a chilled vodka bottle, a bottle of chilled cranberry-juice cocktail (Ocean Spray), a glass, a graduate cylinder, and a beaker.”

Participants are never in short supply for this kind of clinical study. For half the group, the bottle contained 100-proof Smirnoff. The placebo group got flattened tonic water in a glass pre-slimed with vodka, and were later given fake blood-alcohol test results to further the illusion that they’d had a little alcohol. The drinking participants achieved a mean blood alcohol level of 0.067. Participants in the placebo group received a bogus reading of 0.045, which is the “highest credible reading for deceived participants.”

How did the researchers know if the drinkers were zoning out? They asked. But first, they set them to work reading the first five chapters of War and Peace on a computer. The experimenters asked each participant if they had read War and Peace, in whole or in part, before the experiment, and “all indicated that they had not.” (Men aged 21 to 35, recall.) Their task was to read the first 34 pages of the book, or read for 30 minutes, whichever came first. Before starting, the researchers drilled them on the technical description of zoning out: “At some point during reading, you realize that you have no idea what you just read.”

That’s it in a nutshell, and as we all know, you don’t have to be drunk to experience that effect—but it helps. We have all been witness to the drunk who “loses the thread” of his or her monologue and heads off in another linguistic direction altogether, without apparently noticing the shift. The researchers asked participants to hit a special key, helpfully marked “ZO,” when they noticed during reading that they had zoned out. And they used an additional probe measure, interrupting the readers with a tone and asking them if their mind was wandering or concentrated on the text at that moment. At the end of the session, both groups took a 20-question true/false test on what they had read.

So, what were the differences? Both the placebo group and the drinking group spend about the same amount of time reading, and scored roughly the same on the reading comprehension test. No significant differences in reading rates or immediate retention. And when the researchers compared the first, self-reported measure of mind wandering, the two groups were also “similar in the frequency with which they caught themselves zoning out.”

The big difference showed up when researchers compared the frequency of mind wandering as measured by the arbitrary prompts. In that case, the drinkers zoned out twice as often, but were less likely to catch themselves at it. What the drinkers appeared to be sacrificing was a significant degree of meta-awareness, the act of “thinking about thinking.”

So, when they got probed, what were the drinkers thinking about instead of War and Peace? According to the authors, “alcohol seemed to particularly increase distraction related to sensory states, such as hunger, thirst, and other consummatory motives.” One might be tempted to call them “mammalian motives,” in the sense that alcohol intoxication sometimes reduces drinkers to back-brain, lower-order, fight-or-flight responses not highly compatible with meta-cognition.

This is not exactly a groundbreaking study, it’s fair to say. But it does point up the fact that only a few ounces of alcohol can induce episodes of mind wandering which are not detected by the drinker—mini-blackouts, in a manner of speaking.

Although a reduction in working memory capacity is part of the answer, it is not the whole story. What else fuels this “alcohol myopia” is unclear, but the authors suggest that their findings represent the first practical demonstration that “alcohol disrupts individuals’ meta-awareness of the current contents of thought.” Or, as a heavy drinker might be prone to put it, “Now where was I?”

Graphics Credit: http://www.pnas.org/

1 in 25 Global Deaths Linked to Alcohol

Vodka kills more Russians than war, Lancet reports.

A team of researchers at the University of Toronto reported in Lancet that 3.8 % of global deaths could be attributed to alcohol. In Europe, the report stated, the rate of premature death from alcohol was 1 in 10 during 2004, the year studied. And in a related study, more than half of all premature deaths among adult males in Russia were attributable to booze.

The world health care burden, as spelled out by Dr. Jurgen Rehm and others at the University of Toronto, is staggering: “The costs associated with alcohol amount to more than 1% of the gross national product in high-income and middle-income countries, with the costs of social harm constituting a major proportion in addition to health costs.”

In a BBC News report,the study authors warned that the worldwide effect of alcohol-related disease was similar to that of smoking in prior decades. The report takes note of prior research indicating a health benefit from moderate drinking, stressing that any purported benefit is “far outweighed by the detrimental effects of alcohol on disease and injury.”

The Lancet study concludes that the overall mortality figures are “not surprising since global consumption is increasing, especially in the most populous countries of India and China.”

Professor Ian Gilmore of the Royal College of Physicians, quoted by the BBC, called the report “a global wake-up call,” and urged the adoption of “evidence-based measures” for reducing alcohol-related harm, such as price increases and advertising bans. “Many countries are investigating new ways to cut deaths and disease and reduce the burden on health services by using the price of alcohol to lower consumption,” Gilmore said. Pricing strategies have been used effectively in the past to lower cigarette consumption, researchers have noted.

In one of the Russian studies, Professor Richard Peto of the University of Oxford led a statistical analyses, concluding: “If current Russian death rates continue, then about 5% of all young women and 25% of all young men will die before age 55 years from the direct or indirect effects of drinking.” The Russian figures are also affected by the high rate of associated smoking in the former Soviet Union.

Peto added: “When Russian alcohol sales decreased by about a quarter, overall mortality of people of working age immediately decreased by nearly a quarter. This shows that when people who are at high risk of death from alcohol do change their habits, they immediately avoid most of the risk.”

Photo Credit: www.adaweb.net

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Smokers Drink More

It’s no secret that smoking and drinking go together like salt and pepper. No comes further evidence that smoking helps drinkers hold more liquor. Put simply, “Cigarette smoking appears to promote the consumption of alcohol,” says Wei-Jeun Chen of the Texas A&M Health Science Center.

Nicotine seems to slow the movement of alcohol through the intestines, leaving more alcohol molecules backed up and metabolised before reaching the bloodstream by means of intestinal absorption. In animal studies, in which rats were given stomache injections of alcohol and nicotine, clinicians found that “smoking” rats exhibited lower blood-alcohol levels than rats given the same amount of alcohol without the addiction of nicotine.

Dr. David Ball of the Institute of Psychiatry in London, told BBC news: This is a really interesting study. I’m surprised nobody has done it before.”

Chen, an associate professor of neuroscience and experimental therapeutics at Texas A&M College of Medicine, stressed that the results of such “cross tolerance” between alcohol and nicotine could be to “encourage drinkers to drink more to achieve the pleasurable or expected effect.”*

Susan Maier, a spokesperson for the National Institutes of Health (NIH), which sponsored the research, pointed to the potential for harm among young binge drinkers who choose to smoke, and who could “develop chronic alcohol-related diseases earlier in life because of it.”

Conceivably, other drugs might interact with alcohol in a similar fashion. Scientists are beginning to take a look at popular gastric upset products like Pepcid and Tagamet. “Individuals who abuse alcohol are likely to use other drugs,” Chen said. “The potential interactive effects of alcohol and other drugs needs to be considered. For example, the co-use of alcohol and cocaine will result in the formation of cocaethylene, which is highly toxic and has led to a higher mortality rate in animal studies.”

*Coffee and cigarettes go very naturally together as well. This is probably true for as many different reasons as there are coffee drinkers and cigarette smokers, but as we previously noted in the case of alcohol and tobacco, there is a metabolic synergism at work. The two drugs really do seem to have been made for each other. Rats on caffeine will self-administer nicotine faster and more steadily than decaffeinated control rats. This is because nicotine causes caffeine to clear the body at twice the normal rate, thereby allowing coffee or tea drinkers to imbibe larger amounts than usual, whether consciously aware of it or not. In turn, caffeine has an equivalent reinforcing effect on nicotine. The more you smoke, the more coffee you can drink, and vice versa. At the chemical level, smokers may be drinking caffeine in order to more finely balance the mood-altering effects of nicotine. A moment’s reflection brings us to the coffee house, an ancient establishment wherein tobacco and coffee are combined to maximum effect. Coffee and cigarettes, to be sure, are the least psychoactive of the psychoactive drugs—more proof that the sheer intensity of the drug high is not the primary determinant of addiction.

--excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.

Sources:

--Scott E Parnell, James R West, Wei-Jung A Chen. “Nicotine Decreases Blood Alcohol Concentrations in Adult Rats: A Phenomenon Potentially Related to Gastric Function” Alcoholism: Clinical and Experimental Research 30 (8), 2006 1408–1413.

--”Smoking ‘reduces alcohol effect.’” BBC News, July 24, 2006. http://news.bbc.co.uk/go/pr/fr/-/2/hi/5209990.stm.