Identifying the key sociocultural influences on drinking behavior in high and moderate binge-drinking countries and the public policy implications

Despite considerable state investment and initiatives, binge drinking is still a major behavioral problem for policy makers and communities in many parts of the world. Furthermore, the practice of bingeing on alcohol seems to be spreading to young people in countries traditionally considered to have moderate drinking behaviors. Using a sociocultural lens and a framework of sociocultural themes from previous literature to develop propositions from their empirical study, the authors examine binge-drinking attitudes and behaviors among young people from high and moderate binge-drinking countries. The authors then make proposals regarding how policy makers can use social marketing more effectively to contribute to behavior change. Qualitative interviews were conducted with 91 respondents from 22 countries who were studying in two high binge-drinking countries at the time. The results show support for three contrasting sociocultural propositions that identify influences on binge drinking across these countries.

Maintaining or changing a drinking behavior? GOKA's short-term outcomes

During the critical neurobiological and social developmental period of adolescence, binge drinking of alcohol increases the risk of mental health problems, school exclusion, convictions, fatal and non-fatal accidents. The present research utilizes a simple cluster randomized control trial design to evaluate a social marketing program, Game On: Know Alcohol (GOKA), employing innovative online edutainment games to target binge drinking. Pre and post data were collected for seven program (942 students, mean age: 14.6 years) and five control schools (578 students, mean age: 14.4 years). Significant improvements in alcohol knowledge and affective attitude toward binge drinking was observed for adolescents who participated in GOKA compared to the control group, with maintenance of desirable subjective norms, instrumental attitudes and intentions. Given considerable external competition from messages promoting the benefits of alcohol use, a one-off program that modifies incorrect knowledge and alters perceptions of binge drinking as a fun, recreational activity represents an important step. This research contributes to current understanding of social marketing’s capacity to change drivers and maintain inhibitors of binge drinking intentions of adolescents and provides an important basis for future research in the domain.

The influence of families on early adolescent school connectedness : evidence that this association varies with adolescent involvement in peer drinking networks

School connectedness is central to the long term well-being of adolescents, and high quality parent-child relationships facilitate school connectedness. This study examined the extent to which family relationship quality is associated with the school connectedness of pre- and early teenagers, and how this association varies with adolescent involvement in peer drinking networks. The sample consisted of 7,372 10-14 year olds recruited from 231 schools in 30 Australian communities. Participants completed the Communities that Care youth survey. A multi-level model of school connectedness was used, with a random term for school-level variation. Key independent variables included family relationship quality, peer drinking networks, and school grade. Control variables included child gender, sensation seeking, depression, child alcohol use, parent education, and language spoken at home. For grade 6 students, the association of family relationship quality and school connectedness was lower when peer drinking networks were present, and this effect was nonsignificant for older (grade 8) students. Post hoc analyses indicated that the effect for family relationship quality on school connectedness was nonsignificant when adolescents in grade 6 reported that the majority of friends consumed alcohol. The results point to the importance of familyschool partnerships in early intervention and prevention.

Social skills, expectancies, and drinking in adolescents

Research in the field of teenage drinking behavior has shown relationships between both social skills and drinking and alcohol expectancies and drinking. The present research investigated the comparative power of both of these sets of variables in predicting teenage drinking behavior, as well as looking at the contribution of more global cognitive structures. It was hypothesised that adolescents with high alcohol involvement would be discriminated from those with low involvement on the basis of social skills, cognitive structures, and alcohol expectancies. Seven hundred thirty-two adolescents participated in the study. Results indicated that adolescent alcohol involvement was associated with social skills deficits, positive alcohol expectancies, and negative cognitive structures concerning parents and teachers. The results revealed that, although the bulk of the variance in drinking behavior was explained by the independent effects of social skills and expectancies, the interaction of the two constructs explained an additional and significant proportion of the variance. Implications for preventive and treatment programs are discussed.

A prospective study of personality features predictive of early adolescent alcohol misuse

Personality factors implicated in alcohol misuse have been extensively investigated in adult populations. Fewer studies have clarified the robustness of personality dimensions in predicting early onset alcohol misuse in adolescence. The aim of this study was to examine the predictive utility of two prominent models of personality (Cloninger, 1987; Eysenck & Eysenck, 1975) in emergent alcohol misuse in adolescence. One hundred and 92 secondary school students (mean age = 13.8 years, SD = 0.5) were administered measures of personality (Revised Junior Eysenck Personality Questionnaire – abbreviated; Temperament scale of Junior Temperament and Character Inventory) and drinking behavior (quantity and frequency of consumption, Alcohol Use Disorders Identification Test) at Time 1. At 12-month follow-up, 170 students (88.5%) were retained. Hierarchical multiple regressions revealed the dimensions of psychoticism, extraversion, and Novelty-Seeking to be the most powerful predictors of future alcohol misuse in adolescents. Results provide support for the etiological relevance of these dimensions in the development of early onset alcohol misuse. Findings can be used to develop early intervention programs that target personality risk factors for alcohol misuse in high-risk youth.

Negative mood, implicit alcohol-related memory, and alcohol use in young adults: The moderating effect of alcohol expectancy

Objective Alcohol-related implicit (preconscious) cognitive processes are established and unique predictors of alcohol use, but most research in this area has focused on alcohol-related implicit cognition and anxiety. This study extends this work into the area of depressed mood by testing a cognitive model that combines traditional explicit (conscious and considered) beliefs, implicit alcohol-related memory associations (AMAs), and self-reported drinking behavior. Method Using a sample of 106 university students, depressed mood was manipulated using a musical mood induction procedure immediately prior to completion of implicit then explicit alcohol-related cognition measures. A bootstrapped two-group (weak/strong expectancies of negative affect and tension reduction) structural equation model was used to examine how mood changes and alcohol-related memory associations varied across groups. Results Expectancies of negative affect moderated the association of depressed mood and AMAs, but there was no such association for tension reduction expectancy. Conclusion Subtle mood changes may unconsciously trigger alcohol-related memories in vulnerable individuals. Results have implications for addressing subtle fluctuations in depressed mood among young adults at risk of alcohol problems.

The α5 neuronal nicotinic acetylcholine receptor subunits plays an important role in the sedative effects of ethanol but does not modulate consumption in mice

Alcohol use disorders (AUDs) are a major public health problem, and the few treatment options available to those seeking treatment offer only modest success rates. There remains a need to identify novel targets for the treatment of AUDs. The neuronal nicotinic acetylcholine receptors (nAChRs) represent a potential therapeutic target in the brain, as recent human genetic studies have implicated gene variants in the α5 nAChR subunit as high risk factors for developing alcohol dependence. Here, we evaluate the role of 5* nAChR for ethanol-mediated behaviors using α5+/+ and α5-/- mice. We characterized the effect of hypnotic doses of ethanol and investigated drinking behavior using an adapted Drinking-in-the Dark (DID) paradigm that has been shown to induce high ethanol consumption in mice. We found the α5 subunit to be critical in mediating the sedative effects of ethanol. The α5-/- mice showed slower recovery from ethanol-induced sleep, as measured by loss of righting reflex. Additionally the α5-/- mice showed enhanced impairment to ethanol-induced ataxia. We found the initial sensitivity to ethanol and ethanol metabolism to be similar in both α5+/+ and α5-/- mice. Hence the enhanced sedation is likely due to a difference in the acute tolerance of ethanol in mice deficient of the α5 subunit. However the α5 subunit did not play a role in ethanol consumption for ethanol concentrations ranging from 5% to 30% in the DID paradigm. Additionally, varenicline (Chantix®) was effective in reducing ethanol intake in α5-/- mice. Together, our data suggest that the α5 nAChR subunit is important for the sedative hypnotic doses of ethanol but does not play a role in ethanol consumption. Varenicline can be a treatment option even when there is loss of function of the α5 nAChR subunit.

Effect of the increase in "alcopops" tax on alcohol-related harms in young people : a controlled interrupted time series

Objective: To measure alcohol-related harms to the health of young people presenting to emergency departments (EDs) of Gold Coast public hospitals before and after the increase in the federal government "alcopops" tax in 2008. Design, setting and participants: Interrupted time series analysis over 5 years (28 April 2005 to 27 April 2010) of 15-29-year-olds presenting to EDs with alcohol-related harms compared with presentations of selected control groups. Main outcome measures: Proportion of 15-29-year-olds presenting to EDs with alcohol-related harms compared with (i) 30-49-year-olds with alcohol-related harms, (ii)15-29-year-olds with asthma or appendicitis, and (iii) 15-29-yearolds with any non-alcohol and non-injury related ED presentation. Results: Over a third of 15-29-year-olds presented to ED with alcohol-related conditions, as opposed to around a quarter for all other age groups. There was no significant decrease in alcohol-related ED presentations of 15-29-year-olds compared with any of the control groups after the increase in the tax. We found similar results for males and females, narrow and broad definitions of alcoholrelated harms, under-19s, and visitors to and residents of the Gold Coast. Conclusions: The increase in the tax on al copops was not associated with any reduction in alcohol-related harms in this population in a unique tourist and holiday region. A more comprehensive approach to reducing alcohol harms in young people is needed.

Good choices, great future : an applied theatre prevention program to reduce alcohol-related risky behaviours during Schoolies

Introduction and Aims. The contextual and temporal factors of post-school celebratory events ('Schoolies') place young people at elevated risk of excessive drinking compared with other social occasions. This study investigates the impact of an applied theatre prevention program 'Choices' in reducing the risk of drinking and other risk behaviours during Schoolies celebrations. Design and Methods. Choices was delivered in the last term of Year 12 across 28 North Queensland schools. A total of 352 school leavers (43.1% male, mean age=17.14years) completed a questionnaire at Whitsunday Schoolies, Queensland, Australia on 23-24 November 2010. Nearly 49% of respondents had attended Choices. The survey included measures of alcohol use, illicit drug use and associated problems during Schoolies and a month prior to Schoolies. Results. After controlling for gender and pre-Schoolies drinking, school leavers who attended Choices were significantly less likely to report illicit drug use (OR=0.51, P<0.05) and problem behaviours (OR=0.40, P<0.01) than those who did not attend Choices. There was, however, no intervention effect in risky drinking (i.e. drank on 5 or more days, typical amount five or more standard drink and binge drank on 3 or more days) at Schoolies (OR=0.92, P=0.80). Discussion and Conclusions. Delivery of a youth-specific applied theatre prevention program employing a harm minimisation framework may be effective in reducing high-risk behaviours associated with alcohol consumption at celebratory events, even if young people expect to engage in excessive alcohol consumption. [Quek L-H, White A, Low C, Brown J, Dalton N, Dow D, Connor JP. Good choices, great future: An applied theatre prevention program to reduce alcohol-related risky behaviours during Schoolies. Drug Alcohol Rev 2012;31:897–902]

Genome-wide association and genetic functional studies identify autism susceptibility candidate 2 gene (AUTS2) in the regulation of alcohol consumption

Alcohol consumption is a moderately heritable trait, but the genetic basis in humans is largely unknown, despite its clinical and societal importance. We report a genome-wide association study meta-analysis of approximately 2.5 million directly genotyped or imputed SNPs with alcohol consumption (gram per day per kilogram body weight) among 12 population-based samples of European ancestry, comprising 26,316 individuals, with replication genotyping in an additional 21,185 individuals. SNP rs6943555 in autism susceptibility candidate 2 gene (AUTS2) was associated with alcohol consumption at genome-wide significance (P = 4 x 10(-8) to P = 4 x 10(-9)). We found a genotype-specific expression of AUTS2 in 96 human prefrontal cortex samples (P = 0.026) and significant (P < 0.017) differences in expression of AUTS2 in whole-brain extracts of mice selected for differences in voluntary alcohol consumption. Down-regulation of an AUTS2 homolog caused reduced alcohol sensitivity in Drosophila (P < 0.001). Our finding of a regulator of alcohol consumption adds knowledge to our understanding of genetic mechanisms influencing alcohol drinking behavior.

Alexithymia, craving and attachment in a heavy drinking population

Up to fifty per cent of individuals with Alcohol use disorders (AUD) also have alexithymia a personality construct hypothesized to be related to attachment difficulties. The relationship between alexithymia, craving, anxious attachment and alcohol-dependence severity was examined in 254 patients participating in a Cognitive-Behavioral Therapy (CBT) program for alcohol-dependence. Participants completed the Toronto Alexithymia Scale (TAS-20), the Obsessive Compulsive Drinking Scale (OCDS), the Revised Adult Attachment Anxiety Subscale (RAAS-Anxiety) and the Alcohol Use Disorder Identification Test (AUDIT). MANOVA indicated that individuals with alexithymia reported significantly higher levels of total OCDS, obsessive thoughts about alcohol, and compulsive drinking urges and behavior, compared to the non-alexithymic group. Regression analyses found that anxious attachment partially mediated the relationship between alexithymia and craving. Anxious attachment may be a potential treatment target to reduce alcohol consumption in those with alcohol-dependence and alexithymia. Research Highlights ► There were significant relationships of alexithymia, craving and anxious attachment. ► Alexithymic alcoholics reported higher levels of craving and alcoholism severity. ► Anxious attachment partially mediated the relationship of alexithymia and craving.

Cabergoline Decreases Alcohol Drinking and Seeking Behaviors Via Glial Cell Line-Derived Neurotrophic Factor

Background: Cabergoline is an ergotamine derivative that increases the expression of glial cell line-derived neurotrophic factor (GDNF) in vitro. We recently showed that GDNF in the ventral tegmental area (VTA) reduces the motivation to consume alcohol. We therefore set out to determine whether cabergoline administration decreases alcohol-drinking and -seeking behaviors via GDNF. Methods: Reverse transcription polymerase chain reaction (RT-PCR) and Enzyme-Linked ImmunoSorbent Assay (ELISA) were used to measure GDNF levels. Western blot analysis was used for phosphorylation experiments. Operant self-administration in rats and a two-bottle choice procedure in mice were used to assess alcohol-drinking behaviors. Instrumental performance tested during extinction was used to measure alcohol-seeking behavior. The [35S]GTPγS binding assay was used to assess the expression and function of the dopamine D2 receptor (D2R). Results: We found that treatment of the dopaminergic-like cell line SH-SY5Y with cabergoline and systemic administration of cabergoline in rats resulted in an increase in GDNF level and in the activation of the GDNF pathway. Cabergoline treatment decreased alcohol-drinking and -seeking behaviors including relapse, and its action to reduce alcohol consumption was localized to the VTA. Finally, the increase in GDNF expression and the decrease in alcohol consumption by cabergoline were abolished in GDNF heterozygous knockout mice. Conclusions: Together, these findings suggest that cabergoline-mediated upregulation of the GDNF pathway attenuates alcohol-drinking behaviors and relapse. Alcohol abuse and addiction are devastating and costly problems worldwide. This study puts forward the possibility that cabergoline might be an effective treatment for these disorders. © 2009 Society of Biological Psychiatry.

Shaping safe drinking cultures : evoking positive emotion to promote moderate-drinking behaviour

Social marketing by Western governments that use fear tactics and threatening information to promote anti-drinking messages has polarized ‘binge drinking’ and ‘moderate drinking’ through a continuum that implies benefits and harms for both individuals and society. With the goal of extending insights into social marketing approaches that promote safer drinking cultures in Australia, we discuss findings from a study that examines alcohol consumers' moderate-drinking intentions. By applying the theory of planned behaviour and emotions theory, we discuss survey results from a sample of alcohol consumers, which demonstrate that positively framed value propositions that evoke happiness and love are more influential in the processing of an alcohol moderation message for alcohol consumers. The key limitations of this study are the cross-sectional nature of the data and the focal-dependent variable being behavioural intentions rather than behaviours. Research insight into the stronger influence of positive emotions on processing an alcohol moderation message establishes an important avenue for future social marketing communications that moves beyond negative, avoidance appeals to promote behaviour change in drinkers. These research findings will benefit professionals involved in developing social change campaigns that promote and reinforce consumers' positive intentions, with messages about the benefits of controlled, moderate drinking.

Factors associated with health risk behavior among school children in urban Vietnam

Background Health risk behavior among young people is a public health problem in Vietnam. In addition, road traffic injuries are the leading cause of death for those aged 15–29 years. The consequences can be devastating for adolescents and their families, and can create a significant economic burden on society. Objective: The aim of this study was to identify protective and risk factors that may influence three health risk behaviors among school children: suicidal thinking (ST), drinking alcohol (DA), and underage motorbike driving (MD). Methods A cross-sectional survey of 972 adolescents (aged 12–15 years) was conducted in two secondary schools in Hanoi, Vietnam. The schools were purposely selected, one each from the inner city and a suburban area, from which classes (grade 6 to 8) were randomly selected. All students attending classes on survey days took part in the survey. The anonymous, self-completed questionnaire included measures of risk behavior, school connectedness, parental bonding, and other factors. Multivariable regression models were used to examine associations between the independent variables and the three health risk behaviors controlling for confounding factors. Results Young people in the inner city school reported a higher prevalence of all three risk behaviors than those in the suburban area (ST: 16.1% [95% confidence interval, or CI, 12.9–19.3] versus 4.6% [95% CI 2.7–6.5], p<0.001; DA: 20.3% [95% CI 16.8–23.8] versus 8.3% [95% CI 5.8–10.8], p<0.001, and MD: 10.1% [95% CI 7.4–12.8] versus 5.7% [95% CI 3.6–7.8], p<0.01). School connectedness and mother and father care appeared to be significant protective factors. For males, bullying in school was associated with suicidal thoughts, whereas for both males and females, school connectedness may be protective against suicidal ideation. Conclusion This study supports findings from other nations regarding suicidal thoughts and alcohol use, and appears to be one of the first to examine risk and protective factors forMD. Health promotion within schools should be introduced to improve students’ feelings of connectedness in combination with communication and education campaigns focusing on parental care and engaging teachers for the promotion of safer, supportive school environments.

Initial prototype testing of Ray's Night Out: A new mobile app targeting risky drinking in young people

Background Risky single occasion drinking (RSOD; 4 or more drinks in <6 h) more than doubles the risk of injury in young people (15 - 25 years). The potential role of smartphone apps in reducing RSOD in young people is yet to be explored. Objective: To describe the initial prototype testing of ‘Ray's Night Out’, a new iPhone app targeting RSOD in young people. Method Quantitative and qualitative methods were used to evaluate the quality, perceived utility, and acceptability of the app among nine young people (19e23 years). Results Participants reported Ray's Night Out had good to excellent levels of functionality and visual appeal, acceptable to good levels of entertainment, interest and information, and acceptable levels of customization and interactivity. Young people thought the app had high levels of youth appeal, would prompt users to think about their alcohol use limits, but was unlikely to motivate a change in alcohol use in its current form. Qualitative data provided several suggestions for improving the app. Conclusion Following revision, Ray's Night Out could provide an effective intervention for RSOD in non help-seeking young people. A randomized controlled trial is currently underway to test the final prototype of the app.