Extreme binge drinking among 12th-grade students in the United States: prevalence and predictors

Effects of daridorexant on rest/wake activity patterns and drinking in adult rats exposed to chronic ethanol vapor in adolescence

Disturbance in sleep and activity rhythms are significant health risks associated with alcohol use during adolescence. Many investigators support the theory of a reciprocal relationship between disrupted circadian rhythms, sleep patterns, and alcohol usage. However, in human studies it is difficult to disentangle other factors (i.e. lifestyle, psychiatric, genetic) when determining what is causal in the relationship between substance use and sleep/activity disruptions. To this end, we used an animal model of adolescent alcohol exposure whereby male and female Wistar rats are exposed to 5 weeks of intermittent alcohol vapor during adolescence (P22-P57). Five days after ethanol vapor rats were allowed to select to drink alcohol or water in a two-bottle choice procedure for a period of 5 h, 4 days a week for 6 weeks. Activity data was collected using a "Fitbit-like" device during vapor exposure, during acute withdrawal, and after 3 weeks of protracted withdrawal. Significant changes in rest/wake activity and circadian measures were seen during 24-h withdrawal and after 3 weeks of withdrawal. Four weeks following withdrawal, the effects of the dual orexin antagonist, Daridorexant, (DAX 30 mg, 100 mg, or vehicle control), on alcohol drinking and rest and activity rhythms were assessed over a 24 h period. Both daridorexant doses led to changes in circadian measures and rest/wake activity patterns. These results showed that daridorexant reduced activity, but it did not improve rest quality as measured by the mean inactive episode duration and inactive fragmentation ratio. Additionally, we did not find a significant difference in drinking behavior in animals treated with the orexin antagonist. Thus, it appears that data from this animal model do not support the use of this drug to improve adolescent alcohol-induced sleep disturbance and/or to decrease alcohol drinking.

Adolescent binge alcohol exposure accelerates Alzheimer's disease-associated basal forebrain neuropathology through proinflammatory HMGB1 signaling

Human studies suggest that heavy alcohol use may be an etiological factor contributing to the development of Alzheimer's disease (AD) neuropathology. Both alcohol use disorder (AUD) and AD share common underlying neuropathology, including proinflammatory high-mobility group box 1 (HMGB1)-mediated neuroimmune signaling and basal forebrain cholinergic neuron degeneration. Adolescent onset of binge drinking represents a significant risk factor for later development of an AUD, and accumulating evidence suggests that adolescent initiation of heavy alcohol use induces HMGB1 signaling and causes degeneration of the basal forebrain cholinergic system that persists into adulthood. However, it is unknown whether adolescent binge drinking confers increased risk for later development of AD-associated neuropathology through persistent induction of proinflammatory HMGB1 neuroimmune signaling. To investigate this question, we first (Experiment 1) assessed AD-associated neuropathology in the post-mortem human basal forebrain of individuals with AUD and an adolescent age of drinking onset relative to age-matched moderate drinking controls (CONs). In Experiment 2, we treated non-transgenic and 5xFAD male and female mice, which overexpress both mutant human APP and PS1, with adolescent intermittent ethanol (AIE; 5.0 g/kg, i.g. 2-days on/2-days off; postnatal day [P]30 - P55), and assessed AD-associated neuropathology in the adult (P100) basal forebrain. In Experiment 3, 5xFAD female mice received AIE treatment followed by glycyrrhizic acid (150 mg/L), an HMGB1 inhibitor, in drinking water from P56 to P100, and basal forebrain tissue was collected on P100 for assessment of AD-associated neuropathology. In the post-mortem human AUD basal forebrain (Experiment 1), we report upregulation of Hmgb1 and the HMGB1 receptors Rage and Tlr4 as well as microglial activation and increased intraneuronal Aβ1-42 accumulation in association with reduced cholinergic neuron marker expression (ChAT). In the 5xFAD mouse model (Experiment 2), AIE accelerated AD-associated induction of Hmgb1 proinflammatory neuroimmune genes, microglial activation, and reductions of ChAT+ basal forebrain cholinergic neurons in the adult female, but not male, basal forebrain. In Experiment 3, post-AIE treatment with glycyrrhizic acid rescued the AIE-induced acceleration of AD-associated increases in proinflammatory HMGB1 neuroimmune signaling, microglial activation, and persistent reductions of basal forebrain cholinergic neurons in adult 5xFAD female mice. Together, these findings suggest that adolescent binge ethanol exposure may represent an underappreciated etiological factor contributing to onset of AD-associated neuropathology in adulthood through HMGB1- mediated neuroimmune signaling.

Validation of a Questionnaire of Motivations for Moderated and Severe Alcohol Consumption Among College Students

Objective: This work aimed to develop and validate a scale to assess motivations for alcohol drinking among Mexican college students. Methods: The scale design consisted of applying a stimulus phrase to assess motivations for moderate alcohol drinking (up to three drinks per occasion) and severe alcohol consumption (four or more drinks) in 130 college students. The semantic network technique was applied to identify 15 defining motivations (with more considerable semantic weight) for each drinking level, constituting the pilot scale. The pilot scale was validated on 307 students from a public university in Mexico (255 with moderate drinking and 82 with severe consumption). Results: The final number of items per level of drinking was 10 (moderate drinking) and 13 (severe consumption). Internal reliability (Cronbach's alpha) for the first one was 0.886 with three factors that explain 57.5% of the total variance; the second had an alpha of 0.884 with four factors that explain 70.5% of the total variance. All the factors had positive correlations with the risk perception for alcohol drinking, and there was a positive correlation between severe consumption motivation and the risk perception for consumption of other substances. The confirmatory factor analysis showed that the proposed theoretical models adjust to the data with an error of approximately zero (i.e., RMSEA of 0.088 for moderate consumption and 0.074 for severe consumption), which also carefully measures the motivation for moderate and severe alcohol consumption among college students. Conclusions: The new scale is valid and reliable for assessing motivations for moderate and severe alcohol consumption in Mexican college students. This may be a valuable tool to design and evaluate interventions for the prevention of alcohol use among college students.

Impact of Neuroimmune System Activation by Adolescent Binge Alcohol Exposure on Adult Neurobiology

Adolescence is a conserved neurodevelopmental period encompassing maturation of glia and the innate immune system that parallels refinement of brain structures, neurotransmitter systems, and neurocircuitry. Given the vast neurodevelopmental processes occurring during adolescence, spanning brain structural and neurocircuitry refinement to maturation of neurotransmitter systems, glia, and the innate immune system, insults incurred during this critical period of neurodevelopment, could have profound effects on brain function and behavior that persist into adulthood. Adolescent binge drinking is common and associated with many adverse outcomes that may underlie the lifelong increased risk of alcohol-related problems and development of an alcohol use disorder (AUD). In this chapter, we examined the impact of adolescent binge drinking models using the adolescent intermittent ethanol (AIE) model on adult neurobiology. These studies implicate proinflammatory neuroimmune signaling across glia and neurons in persistent AIE-induced neuropathology. Some of these changes are reversible, providing unique opportunities for the development of treatments to prevent many of the long-term consequences of adolescent alcohol misuse.

Effects of adolescent alcohol exposure on oligodendrocyte lineage cells and myelination in mice: Age and subregion differences

Adolescence is an important phase for the structural and functional development of the brain. The immaturity of adolescent brain development is associated with high susceptibility to exogenous disturbances, including alcohol. In this study, the acquisition of conditioned place preference (CPP) in adolescent mice by alcohol (2 g/kg) and the parvalbumin-positive interneurons (PV+ interneurons), oligodendrocyte lineage cells (OPCs), and myelination in the medial prefrontal cortex (mPFC) were assessed. We aim to determine the age- and subregional-specificity of the effects of alcohol. Alcohol (2 g/kg) was injected intraperitoneally on even days, and saline was injected intraperitoneally on odd days. The control group received a continuous intraperitoneal injection with saline. Differences in alcohol-induced CPP acquisition were assessed, followed by immunohistochemical staining. The results showed a pronounced CPP acquisition in 4- and 5-week-old mice. In the mPFC, there were reduced PV+ interneurons and OPCs in 3-week-old mice and reduced oligodendrocyte numbers in 4-week-old mice. The 5-week-old mice showed impaired myelination and a decrease in the number of PV+ interneurons, mature oligodendrocytes, and OPCs in the mPFC. Since the alterations in 5-week-old mice are more pronounced, we further explored the mPFC-associated subregional-specificity. In the alcohol-exposed mice, the oligodendrocyte numbers were decreased in the anterior cingulate cortex (ACC), PV+ interneuron numbers were declined in the prelimbic cortex (PL), and the number of oligodendrocytes, PV+ interneurons, and OPCs was also decreased with impaired myelination in the infralimbic cortex (IL). Our data suggest that adolescent alcohol exposure notably affected the acquisition of CPP, myelin formation, and the counts of PV+ interneurons, mature oligodendrocytes, and OPCs in the mPFC in 5-week-old mice. Also, the IL subregion was the worst-affected subregion of the mPFC in alcohol-exposed 5-week-old mice. It reveals that the effects of alcohol on adolescence and its mPFC myelination show obvious age- and subregional-specificity.

Youth participation in substance use prevention: A national profile, 2011-2019

PURPOSE

Prevention efforts are critical to avoid the negative consequences of substance use in adolescents. This study aimed to examine national trends and sociodemographic differences in adolescents' participation in school-based substance use prevention (SUP) education, community-based SUP programs, as well as family conversations about substance use.

METHODS

Publicly available data for adolescents aged 12-17 from the annual cross-sectional surveys of the National Survey on Drug Use and Health 2011-2019 were analyzed.

RESULTS

Across the survey years, up to 74.9%, 12.2%, and 58.1% of adolescents reported having participated in school-based SUP education, community-based SUP programs, and family conversations about the danger of substance use in the past-year, respectively. From 2011 to 2019, statistically significant decreases were observed in adolescents' participation in school-based SUP education (OR = 0.97, 95% CI: 0.96, 0.98, p < 0.001) and community-based SUP programs (OR = 0.98, 95% CI: 0.97, 0.99, p < 0.001). Meanwhile, no significant changes were observed in adolescents' participation in family conversations about the dangers of substance use. Overall, lower levels of participation in school-based and community-based SUP programs were found in adolescents aged 16-17. Adolescents living in rural areas showed lower levels of participation in school-based SUP programs and family conversations about SUP. Racial/ethnic minority adolescents overall were less likely to participate in conversations with parents about SUP than Whites.

CONCLUSIONS

Further development and implementation of developmentally appropriate, gender-specific, culturally sensitive, and contextually informed SUP programs at school, community, and family levels are needed.

Binge drinking at time of bariatric surgery is associated with liver disease, suicides, and increases long-term mortality

BACKGROUND AND AIMS

Alcohol use disorder has been reported in patients undergoing bariatric procedures, but the pattern of alcohol consumption has not been evaluated. We investigated the prevalence, risk factors, and impact of binge drinking (BD) at the time of surgery and during follow-up.

METHODS

A prospective, longitudinal study of subjects undergoing bariatric surgery was included in the LABS-2 registry between 2006 and 2009. Participants with AUDIT questionnaire at the time of surgery and a minimum of 12 months follow-up were included. BD was defined as consuming ≥5 drinks on at least 1 occasion in the previous month. Liver biopsies were obtained during bariatric procedures in not all cases. Survival analysis was performed with the adjusted Cox regression model and competing risk.

RESULTS

A total of 2257 subjects were included, with a median follow-up of 79 months. The prevalence of BD at time of surgery was 12%, and it raised up to 23% during follow-up. Patients with BD predominantly had a binge eating disorder (OR=1.35 [95% CI: 1.04-1.76]), regularly consumed fast food [OR=1.4 (95% CI: 1.07-1.85)] and used other drugs (OR=2.65 [95% CI: 1.74-4.04]). Within liver biopsies evaluation, BD showed higher hepatic iron deposits (OR=3.00 [95% CI: 1.25-7.21]). BD at the time of surgery was associated with a higher risk of BD during follow-up (OR=10.49 [95% CI: 7.86-14.00]) and long-term mortality (HR: 3.21 [95% CI: 1.67-6.18]). Specific causes of death in these patients with BD were liver disease (p=0.020), suicide (p=0.015), neoplasms (p=0.034), and respiratory (p=0.025).

CONCLUSIONS

The prevalence of BD in patients undergoing bariatric surgery is high and increases the risk of postoperative liver disease, suicides, and long-term mortality.

Alcohol Dependence Among Adult Males in Chengalpattu District, South India: A Mixed Methods Study

Introduction Post-pandemic alcohol consumption is on the rise due to people starting to adapt themselves to the practice of consuming alcoholic beverages at home. In addition to the direct effects of intoxication and addiction, estimates suggest that alcohol contributes to approximately 20-30% of global cases of oesophagal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle accidents. In India, one-fifth of alcohol consumers were found to be alcohol dependent. The study was done with the primary objective of finding out the prevalence of alcohol dependence among alcohol users and exploring the reasons for alcohol dependence among alcohol users in an urban area of Chengalpattu District, Tamil Nadu. Methodology The study design is an explanatory sequential mixed-methods study. It was done among 624 adult male alcohol consumers in the Chennai district, selected by the cluster sampling method in a community setting. The Alcohol Use Disorders Identification Test (AUDIT) was used to diagnose alcohol dependence. Using the purposive sampling method, in-depth interviews were conducted among 24 alcohol-dependent people to explore and understand their experiences, identify common themes, and provide insights into the problem. Quantitative data were analysed using Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY), and qualitative data were analysed using deductive content analysis using Qualcoder software. Results The mean age of the study participants was 38±7 years. Among current alcohol consumers, 16.9% (106/624) were found to be suffering from alcohol dependence. The significant predictors of alcohol dependence were found to be unskilled occupation (adjusted odds ratio [AOR] = 2.09), having suicidal ideation (AOR = 2.4), alcohol consumption by family members (AOR = 1.90), depression (AOR = 3.98), drinking pattern-affected interpersonal relationships (AOR = 2.29), and not receiving health education about alcohol use in school/college (AOR = 1.74). The major themes and codes identified among alcohol dependents were factors related to mental health, physical health, and social factors. Conclusion This study provides essential points of reference for policymakers and primary care physicians to develop prevention strategies for people to understand and overcome the problem of alcohol addiction, and it also sheds light on the burden of alcohol dependence and their lived experiences.

Subjective intoxication predicts alcohol-related consequences at equivalent alcohol concentrations in young adults using ecological momentary assessment and alcohol sensors

OBJECTIVE

Subjective intoxication (SI) when drinking may serve as an internal barometer of whether to continue drinking or engage in potentially unsafe behavior. Mobile assessments offer the potential to use SI as a prospective risk indicator during drinking episodes; little evidence exists for the validity of real-time SI measures. We test the correspondence of SI with estimated blood alcohol concentration and transdermal alcohol concentration (TAC) in young adults' natural settings. We provide a novel test of whether SI features (peak and mean SI) uniquely predict consequences adjusting for alcohol concentration.

METHOD

Two hundred twenty-two heavy-drinking young adults (Mage = 22.3, 64% female, 79% non-Hispanic White, 84% undergraduates) participated in a 6-day study that used ecological momentary assessment of drinking and TAC sensors. SI was assessed every 30 min during drinking episodes. Multilevel modeling was used to test hypotheses.

RESULTS

Momentary SI and estimated blood alcohol concentration had moderate associations at the moment and day levels (standardized βs = 0.5-0.6); SI was moderately associated with TAC at the day level (βs = 0.5). Associations between SI and alcohol concentration varied widely between persons and across days. Day-level SI features predicted consequences when adjusting for alcohol concentration (incidence rate ratios, IRRs = 1.29-1.70).

CONCLUSIONS

Our two-item SI measure shows evidence of validity in real-world settings with heavy-drinking young adults. SI was significantly correlated with alcohol concentration and was a unique predictor of consequences. The strength of these associations varied greatly across persons and days. Real-time SI measurement may be useful in preventive interventions, but continued research is needed into when and for whom momentary SI is most predictive of risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.

Adolescent alcohol drinking interaction with the gut microbiome: implications for adult alcohol use disorder

Reciprocal communication between the gut microbiota and the brain, commonly referred to as the "gut-brain-axis" is crucial in maintaining overall physiological homeostasis. Gut microbiota development and brain maturation (neuronal connectivity and plasticity) appear to be synchronized and to follow the same timeline during childhood (immature), adolescence (expansion) and adulthood (completion). It is important to note that the mesolimbic reward circuitry develops early on, whereas the maturation of the inhibitory frontal cortical neurons is delayed. This imbalance can lead to increased acquirement of reward-seeking and risk-taking behaviors during adolescence, and consequently eventuate in heightened risk for substance abuse. Thus, there is high initiation of alcohol drinking in early adolescence that significantly increases the risk of alcohol use disorder (AUD) in adulthood. The underlying causes for heightened AUD risk are not well understood. It is suggested that alcohol-associated gut microbiota impairment during adolescence plays a key role in AUD neurodevelopment in adulthood. Furthermore, alcohol-induced dysregulation of microglia, either directly or indirectly through interaction with gut microbiota, may be a critical neuroinflammatory pathway leading to neurodevelopmental impairments and AUD. In this review article, we highlight the influence of adolescent alcohol drinking on gut microbiota, gut-brain axis and microglia, and eventual manifestation of AUD. Furthermore, novel therapeutic interventions via gut microbiota manipulations are discussed briefly.

Adolescent Substance Use Disorder in Primary Care: Challenges in Treatment Referral Beyond Access Availability

OBJECTIVE

Fatal overdoses are the third leading cause of death in the pediatric population. Substance use disorders (SUD) screening is not routinely done in primary care practices. Early screening and intervention for adolescent SUD could mitigate future harm.

METHODS

We conducted a 3-month pilot adapting universal screening using the CRAFFT tool in patients aged 12 to 17 presenting to an urban and a rural primary care practice during well-child and acute/sick-child visits. We collaborated with our pediatric addiction service to ensure access availability for further assessment and treatment for all positively screened patients; this was broadly communicated to primary care providers.

RESULTS

There was a higher CRAFFT completion rate in the urban site (90%, vs 52.6% in our rural site). The majority of CRAFFT questionnaires were completed during acute/sick-child visits in both study sites. Moreover, we found a higher positive screen rate in our rural practice (14.6%, vs 2.4% in our urban practice). Only 27% of positively screened patients had substance use addressed by their providers. No pediatric addiction referrals were made.

CONCLUSIONS

Findings suggest provider-level barriers exist despite having adequate specialty referral sources and institutional encouragement. Future work is needed to explore these barriers.

Normative Perceptions of Peer Drinking Distinguish High-Intensity Drinkers from Other Drinking Groups

Background: High-intensity drinking (HID), or drinking that doubles the binge threshold (i.e., 8+/10+ drinks for women/men), is associated with more negative consequences than binge-only drinking. However, research focusing on HID and factors that may delineate HID from other drinking behaviors is lacking. The present study evaluated if perceived norms for peer drinking behavior (i.e., descriptive norms for alcohol quantity and frequency and injunctive norms) differentiated high-intensity drinkers from other drinker statuses. Further, we evaluated the role of perceived norms on odds of HID engagement and HID frequency. Finally, college status, sex, and underage drinker status were evaluated as moderators of the association between perceived norms and HID status/frequency. Methods: Participants were 623 emerging adult drinkers recruited via Craigslist (68.7% male; 69.0% White). Participants completed an online survey on their drinking behaviors and related social factors. Results: Each domain of perceived norms positively associated with drinker status. Higher perceived norms were associated with greater odds of HID and predicted HID frequency. The association between quantity and frequency descriptive norms and HID engagement was stronger for nonstudents and was only significant for males. Underage drinker status did not moderate associations between perceived norms and HID engagement. Conclusions: Findings provided evidence that perceptions of peer drinking behaviors are strong indicators of HID risk and may be especially useful for identifying high-intensity drinking males and nonstudents. The utility of perceived peer norms to differentiate this group of particularly risky drinkers suggests that social-influence-focused intervention approaches, including norms correction, may be efficacious in targeting HID among emerging adults.

Adolescent Intermittent Ethanol Drives Modest Neuroinflammation but Does Not Escalate Drinking in Male Rats

During adolescence, the brain is highly susceptible to alcohol-induced damage and subsequent neuroimmune responses, effects which may enhance development of an alcohol use disorder (AUD). Neuroimmune reactions are implicated in adolescent alcohol exposure escalating adulthood drinking. Therefore, we investigated whether intermittent alcohol exposure in male, adolescent rats (AIE) escalated adult drinking via two-bottle choice (2BC). We also examined the influence of housing environment across three groups: standard (group-housed with enrichment during 2BC), impoverished (group-housed without enrichment during 2BC), or isolation (single-housed without bedding or enrichment throughout). In the standard group immediately after AIE/saline and after 2BC, we also examined the expression of microglial marker, Iba1, reactive astrocyte marker, vimentin, and neuronal cell death dye, FluoroJade B (FJB). We did not observe an escalation of adulthood drinking following AIE, regardless of housing condition. Further, only a modest neuroimmune response occurred after AIE in the standard group: no significant microglial reactivity or neuronal cell death was apparent using this model, although some astrocyte reactivity was detected in adolescence following AIE that resolved by adulthood. These data suggest that the lack of neuroimmune response in adolescence in this model may underlie the lack of escalation of alcohol drinking, which could not be modified through isolation stress.

High-intensity drinking and hours spent drinking

BACKGROUND

High-intensity drinking (HID) is associated with negative consequences, but it remains unclear whether a time qualifier (i.e., time spent drinking) is needed to identify individuals at highest risk. To improve the measurement and conceptualization of HID, we examined the utility of adding a time qualifier to define what constitutes an occasion of HID using repeated daily surveys in a sample of young adults.

METHODS

Participants were selected from a nationally representative sample of 12th-grade students in the United States who participated in the Monitoring the Future (MTF) study in Spring 2018. In 2019 and 2020, young adults (at modal ages 19-20) responded to annual and daily (14 consecutive days per year) online surveys about their alcohol use.

RESULTS

When we compared moderate drinking days (less than 4/5 drinks for women/men), binge drinking days (4-7/5-9 drinks), and HID days (8+/10+ drinks), HID days had the longest duration of drinking (5.2 h), highest peak estimated blood alcohol concentration (eBAC, 0.30%), and greatest drinking pace (2.58 drinks/h). HID was associated with a greater number of negative consequences than either moderate or binge drinking; adjusting for time spent drinking did not impact this interpretation. HID was reported on 10.9% of days; when defined as 8/10+ drinks in 4 h or 2 h, HID was reported on 4.8% and 1.0% of days, respectively. Nearly all differences in eBAC and negative consequences persisted across drinking intensity despite the introduction of time constraints.

CONCLUSIONS

HID days were characterized by both a longer time spent drinking and a more rapid pace of drinking. Adding a time qualifier to the definition of HID would restrict variability by only describing the minority of days and does not improve the distinctions among levels of risk.

Social behavior and neuronal activation in adolescent female Fos-LacZ transgenic rats: Impact of acute ethanol challenge and baseline levels of social preference

In human adolescents, females often report drinking for coping reasons to avoid negative affective states. We have shown previously that adolescent female rats with elevated levels of anxiety-like behavior under social test circumstances, indexed via low social preference are sensitive to anxiolytic effects of ethanol given intraperitoneally (ip) in a low-to-moderate dose range. This study was designed to test the hypothesis that patterns of neuronal activation across brain regions implicated in social activity and social preference (used as an index of low versus high anxiety-like social responding) would be affected by acute ethanol differently in adolescent females with high and low social preference, with initial levels of social preference also predicting ethanol-induced changes in social behavior. Adolescent female Fos-LacZ rats were given social interaction tests on postnatal day (P)33 for determination of baseline levels of responding to an unfamiliar social partner and on P35 following administration of 0 or 0.75 g/kg ethanol. Brain tissue was collected, and expression of β-galactoside (β-gal) was used as an index of neuronal activation. Baseline levels of social preference did not predict social responsiveness to an acute ethanol challenge, whereas significant decreases in this social measure that reflects anxiety-like behavioral alterations were evident in adolescent females challenged with ethanol relative to saline-injected controls, suggesting high sensitivity to the anxiogenic effects of ethanol. Ethanol precipitated negative relationships between social preference and prefrontal cortical activation, decreased neuronal activation of the anterior cingulate cortex, but substantially increased β-gal expression in the central amygdala. These results suggest high sensitivity of the prefrontal cortical regions and central amygdala to ethanol-induced alterations in adolescent Fos-LacZ females and provide a background for further phenotyping of neurons activated by ethanol under social test circumstances.

Associations between Family Factors and Youth Substance Use Across the Rural-Urban Continuum: A Person-/Variable-Centered Approach

Few studies have evaluated the influence of both family factors and geographic location on youth substance use. To address this gap, a person-/variable-centered approach was used to: (1) identify latent profiles of family risk and protective factors for substance use, (2) test profile membership as a predictor of lifetime and 30-day substance use, (3) test rurality, as measured by school geographic location, as a predictor, and (4) explore interaction effects between profile membership and rurality. Youth (N=9,104; 53% female) residing in a state in the southeastern U.S. completed a statewide substance abuse and risk behavior survey including questions about family risk and protective factors and substance use behaviors. Using latent profile analysis to identify subgroups of participants with similar means and variances on the family factors, four latent profiles emerged. Risk of 30-day and lifetime substance use varied across profiles, with the profile characterized by high family-level protective factors and low family-level risk factors indicating the lowest risk for substance use. Urban youth had increased odds of reporting lifetime marijuana use compared to suburban youth; however, geographic location did not appear to confer significantly increased or decreased risk across other substances. No significant interaction results were found. These results emphasize the importance of family functioning on substance use regardless of geographic location, and that evidence-based prevention programming that reduces family risk, strengthens family protection, and is accessible to all types of communities is important to reducing or delaying substance use among youth.

Patterns of alcohol use among middle school students in rural communities: Associations with community violence exposure

Stress-coping theory posits that exposure to stressors, such as community violence, increases risk for early alcohol initiation. The current study identified patterns of alcohol use in an ethnically diverse sample of early adolescents in rural communities, and examined relations between different forms of exposure to community violence and severity of adolescents' alcohol use patterns. Participants were 5011 middle school students (46.4% non-Hispanic White, 25.5% Latinx, and 13.4% Black; 50% female) living in rural communities in the southeastern United States. Latent class analysis identified subgroups that differed in their patterns of lifetime and past 30-day alcohol use, and subgroup differences in exposure to community violence. Five subgroups were identified: abstainers (56.5%), initiators of wine and beer (12.5%); moderately frequent wine and beer users (10.3%); moderately frequent wine, beer, and liquor users who got drunk (12.0%); and highly frequent wine, beer, and liquor users who got drunk (8.6%). Subgroups differed across sex, grade, and racial-ethnic background. Subgroups characterized by severe alcohol use reported more frequent exposure to community violence and physical victimization, while controlling for nonviolent stressors. Consistent with stress-coping theory, the results indicate that experiencing physical victimization and witnessing community violence robustly relate to adolescents' high-risk alcohol use.

The prevalence and determinant factors for alcohol abuse in Gondar city's preparatory schools: a cross-sectional study

Objectives

Alcohol abuse is more prevalent among preparatory schools in Ethiopia. Although alcohol abuse has become a significant health problem in Ethiopia, governmental and non-governmental organizations have not devoted enough attention to preventing and rehabilitating those who have difficulties with alcoholism. This study examined the prevalence and related factors of alcohol abuse in Gondar's preparatory schools.

Methods

The study used a mixed-methods research approach supported by a school-based cross-sectional design from April 2020 to June 2020 to get reliable and valid data. Through the use of stratified sampling techniques, the study drew a total of 196 students who were addicted to alcohol consumption.

Results

The result of this study revealed that most of the students in the study areas drink alcohol occasionally; the reason they engage in alcoholic consumption is to satisfy personal desires and get respite from strain. Moreover, peer pressure and societal and student familial backgrounds were among the factors that exposed students to the heavy drinking habit.

Conclusions

To avoid such barriers, the study urges the schools to work on a wakefulness campaign or make students aware of the adverse effects of alcohol and related substances through school media.

Associations between alcohol demand, delayed reward discounting, and high-intensity drinking in a diverse emerging adult sample

The high-intensity drinking threshold (HID; 8+/10+ drinks for women/men) is more strongly associated with significant alcohol-related health consequences than the more common heavy episodic drinking threshold (HED; 4+/5+ drinks for women/men). Behavioral economic measures of alcohol reward value (demand) and delayed reward discounting (DRD) have shown associations with other alcohol-related risk behaviors and may contribute to efforts to identify individuals who are at risk for HID from the larger subgroup of at-risk drinkers who engage in HED. Logistic regression analyses tested if alcohol demand and DRD were associated with HID in a sample of 477 emerging adults who reported recent heavy drinking. Receiver operating curve (ROC) analyses were conducted to test these variables' ability to classify HID group membership and to select an optimal cutoff score. In logistic regression analyses controlling for typical weekly drinking, demographics, and other variables associated with HID, participants reporting higher demand intensity (amount of alcohol purchased when price is zero; Adjusted Odds Ratio (AOR) = 20.27, 95% CI [5.71, 71.91]) and lower demand elasticity (sensitivity of alcohol consumption to increases in cost; AOR = .29, 95% CI [.11, 72]) were more likely to report HID relative to HED. Omax (maximum alcohol expenditure) and DRD were associated with HID in bivariate, but not in multivariate models. The ROC analysis provided support for an intensity cutoff of 7.5 or higher. These findings suggest that brief alcohol demand curve measures, in particular demand intensity and elasticity, may have utility in identifying individuals who are at risk for HID. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Use of a Fitbit-like device in rats: Sex differences, relation to EEG sleep, and use to measure the long-term effects of adolescent ethanol exposure

BACKGROUND

Sleep difficulties and rhythm disturbances are some of the problems associated with adolescent binge drinking. Recently, animal models of alcohol-induced insomnia have been developed. However, studies in human subjects have recently focused not only on nighttime EEG findings but also on daytime sleepiness and disrupted activity levels as typically measured by activity tracking devices such as the "Fitbit." We sought to develop and test a Fitbit-like device (the "FitBite") in rats and use it to track rest-activity cycles following adolescent alcohol exposure.

METHODS

The effects of 5 weeks of adolescent ethanol vapor or control conditions were evaluated in 48 male and female Wistar rats using FitBite activity while intoxicated, and during acute (24 h post-vapor exposure) and chronic withdrawal (4 weeks post-vapor exposure). Data were analyzed using activity count and cosinor analyses. Fourteen rats were subsequently implanted with cortical electrodes, and data from the FitBite were compared with EEG data to determine how well the FitBite could identify sleep and activity cycles.

RESULTS

Female rats were generally more active than males, with higher circadian rhythm amplitudes and mesors (rhythm-adjusted means) across a 24-h period. There were significant correlations between EEG-estimated sleep and activity counts using the FitBite. When the rats were tested during intoxication after 4 weeks of ethanol vapor exposure, they had significantly less overall activity. Disruptions in circadian rhythm were also found with significant decreases in the circadian amplitude, mesor, and a later shift in the acrophase. At 24 h of ethanol withdrawal, rats had more episodes of activity with shorter durations during the daytime, when rats are expected to spend more of their time sleeping. This effect remained at 4 weeks following withdrawal, but circadian rhythm disruptions were no longer present.

CONCLUSIONS

A Fitbit-like device can be successfully used in rats to assess rest-activity cycles. Adolescent alcohol exposure produced circadian rhythm disturbances that were not observed after withdrawal. Fragmentation of ultradian rest-activity cycles during the light period was found at 24 h and 4 weeks after withdrawal and support data demonstrating the presence of sleep disturbance long after alcohol withdrawal.

Targeting Persistent Changes in Neuroimmune and Epigenetic Signaling in Adolescent Drinking to Treat Alcohol Use Disorder in Adulthood

Studies universally find early age of drinking onset is linked to lifelong risks of alcohol problems and alcohol use disorder (AUD). Assessment of the lasting effect of drinking during adolescent development in humans is confounded by the diversity of environmental and genetic factors that affect adolescent development, including emerging personality disorders and progressive increases in drinking trajectories into adulthood. Preclinical studies using an adolescent intermittent ethanol (AIE) exposure rat model of underage binge drinking avoid the human confounds and support lifelong changes that increase risks. AIE increases adult alcohol drinking, risky decision-making, reward-seeking, and anxiety as well as reductions in executive function that all increase risks for the development of an AUD. AIE causes persistent increases in brain neuroimmune signaling high-mobility group box 1 (HMGB1), Toll-like receptor, receptor for advanced glycation end products, and innate immune genes that are also found to be increased in human AUD brain. HMGB1 is released from cells by ethanol, both free and within extracellular vesicles, that act on neurons and glia, shifting transcription and cellular phenotype. AIE-induced decreases in adult hippocampal neurogenesis and loss of basal forebrain cholinergic neurons are reviewed as examples of persistent AIE-induced pathology. Both are prevented and reversed by anti-inflammatory and epigenetic drugs. Findings suggest AIE-increased HMGB1 signaling induces the RE-1 silencing transcript blunting cholinergic gene expression, shifting neuronal phenotype. Inhibition of HMGB1 neuroimmune signaling, histone methylation enzymes, and galantamine, the cholinesterase inhibitor, both prevent and reverse AIE pathology. These findings provide new targets that may reverse AUD neuropathology as well as other brain diseases linked to neuroimmune signaling. SIGNIFICANCE STATEMENT: Adolescent underage binge drinking studies find that earlier adolescent drinking is associated with lifelong alcohol problems including high levels of lifetime alcohol use disorder (AUD). Preclinical studies find the underage binge drinking adolescent intermittent ethanol (AIE) model causes lasting changes in adults that increase risks of developing adult alcohol problems. Loss of hippocampal neurogenesis and loss of basal forebrain cholinergic neurons provide examples of how AIE-induced epigenetic and neuroimmune signaling provide novel therapeutic targets for adult AUD.

Associations between binge drinking experience, depressive mood, and suicidality in adolescents: Based on the 2021 Korea Youth Risk Behavior Web-based Survey

BACKGROUND

This study aimed to investigate the associations between binge drinking experience (BDE), depressive mood, and suicidality among Korean adolescents.

METHODS

We analyzed the 17th population-based and cross-sectional data from the Korean Youth Risk Behavior Web-based Survey. Multiple logistic regression analysis was performed to compare BDE, depressive mood, and suicidality by sex.

RESULTS

In 54,848 adolescents, the prevalence of BDE was 5.3 % in boys and 4.4 % in girls. The prevalence of suicidal ideation, plans, and attempts among girls was 7.8 %, 2.4 %, and 1.4 %, respectively. The prevalence of suicide attempts among girls with both BDE and depressive moods was higher than that among boys. Boys with both BDE and depressive mood had 12.60 times and 14.50 times higher adjusted odds ratio (aOR) of suicide ideation and plan, respectively, compared with the non-drinking/non-depressed group. Girls with both BDE and depressive mood had 22.06 times higher aOR of suicide attempts than the non-drinking/non-depressed group.

LIMITATIONS

The study has few limitations including the use of self-report questionnaires, participants' response bias, and lack of diagnosis by mental health professionals.

CONCLUSIONS

These findings represent the prevalence of suicidality among South Korean adolescents with BDE or depressive mood. Since adolescents with both BDE and depressive mood showed particularly high suicidality, it is necessary to establish mental health services, such as proper prevention strategies and targeted interventions.

The Relationship between Parental Monitoring, Peer Pressure, and Motivations for Responsible Drinking among Italian Adolescents: The Mediating Role of Positive Alcohol Expectancies

This study investigated the associations between parental monitoring, peer pressure, and motivations for responsible drinking, while also taking the mediating role of positive alcohol expectancies into account. The participants were 579 Italian adolescents, aged 14-20 years (M = 16.39 years, SD = 1.27; 55.3% females), involved in a cross-sectional survey. They were administered online self-report questionnaires. Structural equation modeling revealed both direct and indirect positive associations between study variables. Parental monitoring was positively associated, both directly and indirectly, with adolescents' motivations for responsible drinking through the mediation of positive alcohol expectancies; peer pressure was negatively and indirectly associated with adolescents' motivations for responsible drinking, via the mediating role of positive alcohol expectancies. Findings highlighted the importance of environmental factors with regard to motivations for responsible drinking, suggesting the opportunity to implement prevention programs to improve parental monitoring and increase adolescents' skills to manage peer pressure and to develop realistic expectancies about drinking.

Past year high-intensity drinking moderates the association between simultaneous alcohol and marijuana use and blackout frequency among college students

Objective: The role of simultaneous alcohol and marijuana (SAM) use in the experience of blackouts among college students is unclear. To clarify discrepancies, the current study evaluated whether the association between SAM user status and blackouts was moderated by high-intensity drinking (HID). Participants and Methods: College students (N = 1,224; 63.7% female) reported on their past year experiences of blackout, marijuana use, SAM use, and HID (i.e., drinking at least twice the binge threshold). Results: SAM users had more past year blackouts than non-SAM users, but this effect was only significant among SAM users who had engaged in HID in the past year (nonbinge: F(5,37) = 0.50, p = 0.49; binge: F(5,138) = 0.23, p = 0.63; HID: F(5,328) = 4.52, p = 0.03). Conclusions: Effects of SAM user status on the experience of alcohol-related blackouts may be limited to individuals who engage in HID.

A Comparative Study on Health Risks, Lifestyle Behaviors, Health Perceptions, and Health Seeking Patterns between Older and Younger Filipinos in the Rural Areas

Background

Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥ 60 years).

Objectives

This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines.

Methods

A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests.

Results

Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician.

Conclusion

There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.

Ethanol-induced conditioned taste aversion and associated neural activation in male rats: Impact of age and adolescent intermittent ethanol exposure

Individuals that initiate alcohol use at younger ages and binge drink during adolescence are more susceptible to developing alcohol use disorder. Adolescents are relatively insensitive to the aversive effects of alcohol and tend to consume significantly more alcohol per occasion than adults, an effect that is conserved in rodent models. Adolescent typical insensitivity to the aversive effects of alcohol may promote greater alcohol intake by attenuating internal cues that curb its consumption. Attenuated sensitivity to the aversive effects of alcohol is also retained into adulthood following protracted abstinence from adolescent intermittent ethanol (AIE) exposure. Despite these effects, much remains unknown regarding the neural contributors. In the present study, we used a conditioned taste aversion (CTA) paradigm to investigate neuronal activation in late-developing forebrain structures of male adolescents and adult cFos-LacZ transgenic rats as well as in AIE adults following consumption of 0.9% sodium chloride previously paired with an intraperitoneal injection of 0, 1.5 or 2.5 g/kg of ethanol. Adults that were non-manipulated or received water exposure during adolescence showed CTA to both ethanol doses, whereas adolescents displayed CTA only to the 2.5 g/kg ethanol dose. Adults who experienced AIE did not show CTA. Adults displayed increased neuronal activation indexed via number of β-galactosidase positive (β-gal+) cells in the prefrontal and insular cortex that was absent in adolescents, whereas adolescents but not adults had a reduced number of β-gal+ cells in the central amygdala. Adults also displayed greater cortical-insular functional connectivity than adolescents as well as insular-amygdalar and prefrontal cortex-accumbens core functional connectivity. Like adolescents, adults previously exposed to AIE displayed reduced prefrontal-insular cortex and prefrontal-accumbal core functional connectivity. Taken together, these results suggest that attenuated sensitivity to the aversive effects of ethanol is related to a loss of an insular-prefrontal cortex-accumbens core circuit.

Meta-analytic evidence for a sex-diverging association between alcohol use and body mass index

Alcohol use is an important health issue and has been suggested to contribute to the burden produced by obesity. Both alcohol use and obesity are subject to sex differences. The available studies on the relationship between alcohol use and body mass index (BMI) report inconsistent results with positive, negative, and null findings which requests a meta-analytic approach. Therefore, we conducted a meta-analysis of case-control, cohort, and cross-sectional studies. The systematic literature search and data extraction was performed by 3 independent raters. We conducted sex-separated meta-analyses and -regressions to investigate how alcohol consumption associates with BMI. Our systematic literature search resulted in 36 studies with 48 data sets (Nmen = 172,254; kmen = 30; Nwomen = 24,164; kwomen = 18; Nunknown sex = 672,344; kunknown sex = 24). Alcohol use was associated with higher BMI in men (g = 0.08 [0.07; 0.09]) and lower BMI in women (g = - 0.26 [- 0.29; - 0.22]). Moreover, we found the amount of daily alcohol intake in men (β = 0.001 [0.0008; 0.0014]) and ethnicity in women (g[Caucasians] = - 0.45 versus g[Asians] = - 0.05; z = 11.5, p < 0.0001) to moderate these effects. We here identified sex-diverging relationships between alcohol use and BMI, found daily alcohol intake and ethnicity to sex-specifically moderate these effects, and argue that sex-specific choice of beverage type and higher amount of daily alcohol use in men than in women account for these observations. Future research is needed to provide empirical evidence for the underlying mechanisms.

Heterogeneity of definitions and measurements of binge drinking in research on adolescents and young adults

INTRODUCTION

Binge drinking is a widespread health compromising behaviour among adolescents and young adults and is one of the leading causes of mortality and injuries among this population. The definitions and measurement methods of binge drinking are heterogeneous but constitute a crucial component in the literature on associated factors related to binge drinking. This study focused on how binge drinking is defined and measured in the literature exploring its associated risk factors among adolescents and young adults.

METHODS

The databases PubMed, Embase, PsycINFO and Social Care were searched for articles published between 1 January 2006 and 30 April 2020 using 3 concepts: binge drinking; risk or protective factors; and adolescents/young adults with respective key words. Data were extracted on the main characteristics of studies and the parameters of binge drinking measurements.

RESULTS

173 studies were included, mostly cross-sectional (61 %) and longitudinal (38 %). Only 23 % of the studies explicitly referred to a standardised definition of binge drinking even though 76 % of the studies used a consensual threshold of 5 drinks or more for men. A lower threshold for women was applied in 26 % of the studies. Recall periods ranged between 2 weeks and 1 year in 85 % of the studies and only 16 % presented binge drinking in terms of frequency and/or quantity of drinks.

CONCLUSION

Our results highlight the heterogeneity in the definitions and measurements of binge drinking, raising concerns for meaningful comparisons between studies focused on factors associated with the behaviour. The scientific community needs to be aware of these variations and address the gap of poor stratification and inconsistencies in binge drinking reporting.

Trends in Deaths Fully Attributable to Alcohol in Minnesota, 2000-2018

OBJECTIVE

Overall trends in rates of fully alcohol-attributable mortality may mask disparities among demographic groups. We investigated overall, demographic, and geographic trends in fully alcohol-attributable mortality rates in Minnesota.

METHODS

We obtained mortality data from Minnesota death certificates and defined fully alcohol-attributable deaths as deaths that would not occur in the absence of alcohol. We calculated age-adjusted death rates during 2000-2018 using 5-year moving averages stratified by decedents' characteristics and geographic location.

RESULTS

Chronic conditions accounted for most of the alcohol-attributable deaths in Minnesota (89% during 2014-2018). Alcohol-attributable mortality rates per 100 000 population increased from an average rate of 8.0 during 2000-2004 to 12.6 during 2014-2018. During 2000-2018, alcohol-attributable mortality rates were highest among males (vs females), adults aged 55-64 (vs other ages), and American Indian/Alaska Native people (vs other racial and ethnic groups) and lowest among people aged ≤24 years and Asian or Pacific Islander people. During 2014-2018, the alcohol-attributable mortality rate among American Indian/Alaska Native people was more than 5 times higher than the overall mortality rate in Minnesota.

CONCLUSIONS

Results from this study may increase awareness of racial and ethnic disparities and continuing health inequities and inform public health prevention efforts, such as those recommended by the Community Preventive Services Task Force, including regulating alcohol outlet density and increasing alcohol taxes.

The Role of the Adenosine System on Emotional and Cognitive Disturbances Induced by Ethanol Binge Drinking in the Immature Brain and the Beneficial Effects of Caffeine

Binge drinking intake is the most common pattern of ethanol consumption by adolescents, which elicits emotional disturbances, mainly anxiety and depressive symptoms, as well as cognitive alterations. Ethanol exposure may act on the adenosine neuromodulation system by increasing adenosine levels, consequently increasing the activation of adenosine receptors in the brain. The adenosine modulation system is involved in the control of mood and memory behavior. However, there is a gap in the knowledge about the exact mechanisms related to ethanol exposure’s hazardous effects on the immature brain (i.e., during adolescence) and the role of the adenosine system thereupon. The present review attempts to provide a comprehensive picture of the role of the adenosinergic system on emotional and cognitive disturbances induced by ethanol during adolescence, exploring the potential benefits of caffeine administration in view of its action as a non-selective antagonist of adenosine receptors.

Alarming Trends: Mortality from Alcoholic Cirrhosis in the United States

BACKGROUND

Alcoholic cirrhosis is an advanced form of alcohol-related liver disease. In the United States, between 2010 and 2016, alcohol-related liver disease was the primary cause of nearly 1 in 3 liver transplants, surpassing hepatitis C.

METHODS

We utilized the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database to compare trends in mortality from alcoholic cirrhosis in the United States in 1999 and 2019. We defined mortality from alcoholic cirrhosis as International Classification of Diseases code K70.3 (alcoholic cirrhosis of liver). We calculated mortality rates and mortality rate ratios (MRRs) per 100,000 from alcoholic cirrhosis in 10-year age groups from 25 to 85+ as measures of effect and 95% confidence intervals to test for significance.

RESULTS

In 1999, there were 6007 deaths from alcoholic cirrhosis among 180,408,769 aged 25-85+ years, yielding a mortality rate of 3.3 per 100,000. In 2019, there were 23,780 deaths from alcoholic cirrhosis among 224,981,167 aged 25-85+ years, yielding a mortality rate of 10.6 per 100,000. The overall MRR of 3.2 was statistically significant. (P < .001), and was apparent in each 10-year age group.

CONCLUSIONS

These alarming trends in mortality from alcoholic cirrhosis in the United States contribute to the formulation of many hypotheses. These require testing in analytic studies designed a priori to do so. Meanwhile, clinical and public health efforts are necessary to curb the epidemics of heavy alcohol consumption and overweight and obesity in the United States that may be contributing to these alarming trends.

The role of anterior insular cortex inputs to dorsolateral striatum in binge alcohol drinking

How does binge drinking alcohol change synaptic function, and do these changes maintain binge consumption? The anterior insular cortex (AIC) and dorsolateral striatum (DLS) are brain regions implicated in alcohol use disorder. In male, but not female mice, we found that binge drinking alcohol produced glutamatergic synaptic adaptations selective to AIC inputs within the DLS. Photoexciting AIC→DLS circuitry in male mice during binge drinking decreased alcohol, but not water consumption and altered alcohol drinking mechanics. Further, drinking mechanics alone from drinking session data predicted alcohol-related circuit changes. AIC→DLS manipulation did not alter operant, valence, or anxiety-related behaviors. These findings suggest that alcohol-mediated changes at AIC inputs govern behavioral sequences that maintain binge drinking and may serve as a circuit-based biomarker for the development of alcohol use disorder.

Patterns and predictors of high-intensity drinking and implications for intervention

Efforts to intervene with subgroups at particularly high risk for alcohol use require information on factors that differentiate drinking intensity levels. This article summarizes existing research and provides new findings on sociodemographics and risk factors that differentiate high-intensity drinking (HID) to provide context for developing and delivering interventions for the highest-risk drinkers. Cross-sectional data were obtained in 2019 from participants who reported past 30-day alcohol use in 2018 as part of the nationally representative 12th grade Monitoring the Future study. Among past 2-week drinkers in 2019 (N = 601; modal age 19; 57.0% male; 67.4% non-Hispanic White), bivariate associations between drinking intensity (moderate drinking [1-4 drinks for women/1-5 drinks for men], binge-only drinking [4-7/5-9 drinks], and HID [8+/10+ drinks]) and a range of sociodemographic characteristics, risk factors, and alcohol-related consequences were examined. Results showed binge-drinking norms, social and enhancement drinking motives, nicotine vaping, and use of limiting/stopping drinking and manner of drinking protective behavioral strategies differentiated all drinking intensity levels, lending support to HID and binge-only drinking having an overlapping risk profile. However, there were also risk factors uniquely associated with HID, including sex, college attendance, employment, HID norms, use of serious harm reduction protective behavioral strategies, family history of drinking problems, any cigarette or drug use other than marijuana, and depression symptoms. Therefore, risk factors differentiate young adult drinking intensity. These results can inform efforts to adapt interventions for young adults who report HID. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Solitary alcohol use in adolescence predicts alcohol problems in adulthood: A 17-year longitudinal study in a large national sample of US high school students

BACKGROUND

Identifying risk factors for alcohol use disorder (AUD) is important for public health. The social context of drinking-such as drinking alone-may be an independent and robust early risk marker for AUD symptoms later in life. We evaluated whether solitary alcohol use in adolescence (age 18) and young adulthood (age 23/24) was concurrently associated with binge drinking and prospectively predicted age 35 AUD symptoms, and whether associations differed by sex.

METHODS

Longitudinal data were from the Monitoring the Future study. Surveys were completed by adolescents in 12th grade at age 18 (1976-2002), young adults at age 23/24 (1981-2008), and adults at age 35 (1993-2019). Analyses included past 12-month alcohol users (n = 4464 for adolescent models; n = 4561 for young adult models). Multivariable regression analyses tested whether adolescent and young adult solitary alcohol use was associated concurrently with binge drinking frequency and prospectively with age 35 AUD symptoms.

RESULTS

Solitary alcohol use in adolescence and young adulthood was associated (a) concurrently with binge drinking and (b) prospectively with increased risk of age 35 AUD symptoms (even after controlling for earlier binge drinking, alcohol use frequency, and sociodemographic covariates). Adolescent solitary alcohol use was associated with age 35 AUD symptoms particularly among females; no interaction was observed between sex and young adult solitary alcohol use in predicting age 35 AUD symptoms.

CONCLUSIONS

Adolescent and young adult solitary alcohol use was associated with increased adult AUD symptoms above and beyond other risk factors; adolescent female solitary alcohol users were especially at risk.

Racial/Ethnic Bullying Subtypes and Alcohol, Tobacco, and Marijuana Use Among US Adolescents

BACKGROUND

The study examines the rate of alcohol, tobacco, and marijuana use among White, African American, and Latino adolescents and whether racial/ethnic bullying subtypes (victim-only, bullies-only, and bully/victim) are related to alcohol, tobacco, and marijuana use.

METHODS

We used data from the 2009-2010 Health Behaviour in School-aged Children study (n = 9863) to examine differences in alcohol, tobacco, and marijuana use among White, African American, and Latino adolescents in the USA, and assessed whether racial/ethnic bullying involvement was associated with alcohol, tobacco, and marijuana use among these adolescents. Adolescents were categorized into four groups based on whether they had experienced racial bullying perpetration, victimization, both perpetration, and victimization, or neither perpetration nor victimization. Descriptive statistics were conducted to examine the distributions of the study variables and describe the samples. Spearman's rank-order correlation analyses were used to examine the relationships among the variables. Multinomial logistic regression was conducted to examine alcohol, tobacco, and marijuana use among the racial bully victimization, perpetration, and victimization-perpetration groups compared to the non-involved group by race/ethnicity.

RESULTS

The White victim-only group was more likely to use alcohol but less likely to use tobacco. The African American victim-only group was more likely to use alcohol, and the bully/victim group was more likely to use marijuana. The Latino victim-only group was more likely to use alcohol, whereas the bully/victim group was more likely to use tobacco.

CONCLUSION

Our findings have implications for the development and implementation of prevention and intervention programs across different racial/ethnic adolescent groups.

Individual-, peer-, and parent-level substance use-related factors among 9- and 10-year-olds from the ABCD Study: Prevalence rates and sociodemographic differences

Background

Although a relatively large body of research has identified multiple factors associated with adolescent substance use, less is known about earlier substance-related factors during preadolescence, including curiosity to use substances. The present study examined individual-, peer-, and parent-level domains pertaining to substance use and how these domains vary by sociodemographic subgroups and substance type.

Methods

Participants were 11,864 9- and 10-year-olds from the baseline sample of the Adolescent Brain Cognitive Development (ABCD) Study. Youth-reported measures were curiosity to use substances and perceived peer substance use. Parent-reported measures were availability of and rules about substances. Generalized logistic mixed models (GLMM) were used to compare these measures across alcohol, nicotine, and marijuana and across sociodemographic subgroupings (sex, race/ethnicity, household income, and family history of alcohol problems). GLMM was then used to examine predictors of curiosity to use by substance type.

Results

The most striking descriptive differences were found between race/ethnicity and income categories (e.g., positive associations between greater income and greater availability of alcohol). In multivariable analyses, greater curiosity to use alcohol was associated with being male, higher household income, perceived peer alcohol use, and easy alcohol availability; greater curiosity to use nicotine was associated with being male, perceived peer cigarette use, easy availability of cigarettes, and no parental rules about cigarette use.

Conclusions

This study identified substance use-related individual-, peer-, and parent-level factors among a diverse, national sample. Findings highlight the importance of considering sociodemographic and substance-specific variability and may help identify risk and protective factors preceding adolescent substance use.

Alcohol and Nicotine Use among Adolescents: An Observational Study in a Sicilian Cohort of High School Students

In recent years, the mode of alcoholic intake known as binge drinking (BD) has become a common practice, especially among adolescents who, due to socio-environmental motives, tend to reach a rapid state of drunkenness. This drunkeness leads to alterations in brain areas responsible for executive functions and cognitive processes, as well as to the genesis of factors that predispose to lasting addiction. Likewise, nicotine leads to a comparable degree of addiction. On this basis, the aim of this research was to evaluate, on a cohort of 349 high school students (15−17 years old) in the province of Palermo, the following: (I) the drinking model of alcoholic beverages; (II) the use of nicotine and the degree of dependence; (III) the correlation between the consumption of alcoholic beverages and the use of nicotine. We employed the AUDIT-C test and the Fagerström test, two valid and standard instruments, in order to assess alcohol and nicotine use, respectively. Statistical analysis of the data showed that male and female students consumed alcohol prominently in a BD mode (77.2%, audit score (AS) 3.497, confidence interval (CI) 3.206−3.788; 69.6%, AS 2.793, CI 2.412−3.274) and nicotine (41.5%, Fagerström score (FS) 3.882, CI 3.519−4.245; 28%, FS 3.286, CI 2.547−4.024). Furthermore, a positive correlation between alcohol consumption and nicotine use was found for male (r = 0.6798, p < 0.0001) and female (r = 0.6572, p < 0.0001) students. This study provided further insights into the use of legal substances of abuse in adolescents, evidencing the obvious need for the promotion of specific school educational programs aimed at the wellbeing of youth populations.

Cholinergic and Neuroimmune Signaling Interact to Impact Adult Hippocampal Neurogenesis and Alcohol Pathology Across Development

Alcohol (ethanol) use and misuse is a costly societal issue that can affect an individual across the lifespan. Alcohol use and misuse typically initiates during adolescence and generally continues into adulthood. Not only is alcohol the most widely abused drug by adolescents, but it is also one of the most widely abused drugs in the world. In fact, high rates of maternal drinking make developmental ethanol exposure the most preventable cause of neurological deficits in the Western world. Preclinical studies have determined that one of the most consistent effects of ethanol is its disruption of hippocampal neurogenesis. However, the severity, persistence, and reversibility of ethanol’s effects on hippocampal neurogenesis are dependent on developmental stage of exposure and age at assessment. Complicating the neurodevelopmental effects of ethanol is the concurrent development and maturation of neuromodulatory systems which regulate neurogenesis, particularly the cholinergic system. Cholinergic signaling in the hippocampus directly regulates hippocampal neurogenesis through muscarinic and nicotinic receptor actions and indirectly regulates neurogenesis by providing anti-inflammatory regulatory control over the hippocampal environmental milieu. Therefore, this review aims to evaluate how shifting maturational patterns of the cholinergic system and its regulation of neuroimmune signaling impact ethanol’s effects on adult neurogenesis. For example, perinatal ethanol exposure decreases basal forebrain cholinergic neuron populations, resulting in long-term developmental disruptions to the hippocampus that persist into adulthood. Exaggerated neuroimmune responses and disruptions in adult hippocampal neurogenesis are evident after environmental, developmental, and pharmacological challenges, suggesting that perinatal ethanol exposure induces neurogenic deficits in adulthood that can be unmasked under conditions that strain neural and immune function. Similarly, adolescent ethanol exposure persistently decreases basal forebrain cholinergic neuron populations, increases hippocampal neuroimmune gene expression, and decreases hippocampal neurogenesis in adulthood. The effects of neither perinatal nor adolescent ethanol are mitigated by abstinence whereas adult ethanol exposure-induced reductions in hippocampal neurogenesis are restored following abstinence, suggesting that ethanol-induced alterations in neurogenesis and reversibility are dependent upon the developmental period. Thus, the focus of this review is an examination of how ethanol exposure across critical developmental periods disrupts maturation of cholinergic and neuroinflammatory systems to differentially affect hippocampal neurogenesis in adulthood.

Prenatal opioid exposure reprograms the behavioural response to future alcohol reward

As the opioid crisis has continued to grow, so has the number of infants exposed to opioids during the prenatal period. A growing concern is that prenatal exposure to opioids may induce persistent neurological changes that increase the propensity for future addictions. Although alcohol represents the most likely addictive substance that the growing population of prenatal opioid exposed will encounter as they mature, no studies to date have examined the effect of prenatal opioid exposure on future sensitivity to alcohol reward. Using a recently developed mouse model of prenatal methadone exposure (PME), we investigated the rewarding properties of alcohol and alcohol consumption in male and female adolescent PME and prenatal saline exposed (PSE) control animals. Conditioned place preference to alcohol was disrupted in PME offspring in a sex-dependent manner with PME males exhibiting resistance to the rewarding properties of alcohol. Repeated injections of alcohol revealed enhanced sensitivity to the locomotor-stimulating effects of alcohol specific to PME females. PME males consumed significantly more alcohol over 4 weeks of alcohol access relative to PSE males and exhibited increased resistance to quinine-adulterated alcohol. Further, a novel machine learning model was developed to employ measured differences in alcohol consumption and drinking microstructure to reliably predict prenatal exposure. These findings indicate that PME alters the sensitivity to alcohol reward in adolescent mice in a sex-specific manner and suggests prenatal opioid exposure may induce persistent effects on reward neurocircuitry that can reprogram offspring behavioural response to alcohol later in life.

Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults

BACKGROUND

The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S.

METHODS

We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review.

RESULTS

The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving.

CONCLUSION

This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.

Alcohol use is prevalent among adults with the fontan circulation but does not correlate with liver disease

Background

Alcohol consumption is associated with an increased risk of liver disease. There are limited studies on the epidemiology of alcohol use and its effects on Fontan-associated liver disease (FALD) in adulthood.

Methods

In this single-center prospective cohort study, patients were enrolled from the Fontan clinic between November 2019 and November 2020, excluding those with chronic hepatitis C or B. Alcohol consumption was quantified by Alcohol Use Disorders Identification Test (AUDIT) questionnaire and a supplementary questionnaire. Participants were stratified into alcohol consumers and non-consumers. Alcohol consumption was correlated to the magnitude of fibrosis on liver biopsy and the varices, ascites, splenomegaly, and thrombocytopenia (VAST) score.

Results

Forty-three patients (age 30 ​± ​6.5 years) were enrolled, and most were in NYHA FC 1 or 2. Twenty-six (60.5%) participants consumed alcohol regularly in the past year (twenty with low-risk consumption and six with hazardous consumption). Alcohol consumers were more likely to have better NYHA FC. Of those, half reported alcohol consumption for longer than one year before enrollment. Eleven (25.6%) participants reported underage drinking. After multivariable adjustment, male sex was associated with increased severity of liver fibrosis (OR 3.7 [1.0 to 13.6]). Alcohol consumption was not associated with liver fibrosis (OR 1.2 [0.3 to 4.9]) or VAST scores (OR 1.2 [0.01 to 2.2]).

Conclusions

Alcohol consumption is prevalent among adults with the Fontan circulation but does not correlate with FALD. However, further studies are required to validate the results in cohorts with heavier alcohol consumption. Underage drinking was prevalent and warrants screening in pediatrics.

Hazardous alcohol use and alcohol-related harm in rural and remote communities: a scoping review

Alcohol use is a major risk factor for death and disease worldwide and alcohol-related harms appear to be more prevalent in rural and remote, relative to urban, communities. This Review synthesised international research on rural-urban disparities in hazardous and harmful alcohol use and risk factors for these outcomes within rural and remote communities. 280 studies from 49 countries were included in the Scoping Review. Most studies (60%) found rural, relative to urban, residence to be associated with an increased likelihood of hazardous alcohol use or alcohol-related harm. This proportion increased between 1990 and 2019 and varied by country, age group, and outcome type, being highest in Australia, among young adults, and for more severe alcohol-related harms, such as drink driving and alcohol-related suicide. Improved public health strategies to reduce the burden of alcohol use in rural communities are required but their efficacy will depend on how well they are tailored to the unique needs of the region they are implemented in.

Extreme Binge Drinking During Adolescence: Associations With Subsequent Substance Use Disorders in American Indian and Mexican American Young Adults

OBJECTIVE

This study collected retrospective data on adolescent binge drinking (ABD) (5 drinks for boys, 4 for girls per occasion at least once per month) and/or extreme adolescent binge drinking (EABD) (10 or more drinks per occasion at least once per month) and tested for associations with demographic and diagnostics variables including alcohol and other substance use disorders (AUD/SUD).

METHODS

Cross-sectional data were collected from young adult (age 18-30 yrs) American Indians (AI) (n = 534) and Mexican Americans (MA) (n = 704) using a semi-structured diagnostic instrument.

RESULTS

Thirty percent (30%) of the sample reported ABD and 21% reported EABD. Those having had monthly ABD were more likely to be AI and have less education; those having had EABD were more likely to be AI, male, younger, have less education and lower economic status compared to participants without ABD. ABD/EABD was associated with higher impulsivity, a family history of AUD, and lower level of response to alcohol (ORs = 1.0-2.0), as well as with adult AUD (ORs = 3.7-48), other substance use disorders (ORs = 3.5-9), and conduct disorder/ antisocial personality disorder (ORs = 2.0-2.6), but not with anxiety/depression. Monthly EABD further increased the odds of AUD/SUD.

CONCLUSIONS

Although binge drinking was more common in AI compared to MA, there were little effects of race in individual risk factor analyses. Monthly ABD and EABD were common among these AI/MA as adolescents, and, as with other ethnic groups, these drinking patterns resulted in highly significant increases in the odds of developing alcohol and other substance use disorders in young adulthood.

Age of Initiation of Dual Tobacco Use and Binge Drinking among Youth (12-17 Years Old): Findings from the Population Assessment of Tobacco and Health (PATH) Study

Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7-5.2) and 2.0% (95% CI: 1.2-2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.

Addressing methodological issues in a study of impulsivity and vulnerability for transition to alcohol use disorder

BACKGROUND

Heightened behavioral impulsivity has been advocated as a preexisting risk factor for the development of alcohol use disorder (AUD). Nonetheless, studies investigating impulsivity in adolescent/young adult at-risk drinkers-who are at increased risk of developing AUD-report mixed findings. This may be due to methodological limitations related to definitions of at-risk drinking, the retrospective assessment of alcohol intake, and/or the relatively modest sample size of some studies.

METHODS

Healthy individuals (N = 814, M_age  = 22.50) completed online surveys and a measure of choice impulsivity. Of these, a number of participants also undertook an online measure of response inhibition (n = 627, M_age  = 22.66), and a further subgroup submitted real-time alcohol consumption information for a period of 21 days using an app (n = 543, M_age  = 22.96). Differences in behavioral impulsivity were assessed as a function of various at-risk alcohol intake categories. Hierarchical multiple regression was employed to determine whether impulsivity predicted alcohol use in the form of a continuous index comprising variables related to intake and consequences of use.

RESULTS

Significantly greater impulsivity was not evident in heavy, standard binge, high binge, harmful, or hazardous alcohol drinkers as compared to controls, regardless of the criteria employed to categorize these at-risk drinkers. Neither choice impulsivity nor reduced response inhibition significantly predicted the alcohol use index.

CONCLUSIONS

While results could be attributed to the online nature of this research, it is possible that more sensitive measures of behavioral impulsivity are required when assessing nondependent drinkers.

NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040

BACKGROUND AND AIMS

Mortality secondary to cirrhosis in North America is increasing. We describe the incidence of cirrhosis stratified by birth cohort and cirrhosis etiology and project disease burden to 2040.

APPROACH AND RESULTS

This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with incident cirrhosis (2000-2017) were identified, and etiology was defined as HCV, HBV, NAFLD, alcohol-associated liver disease (ALD), or autoimmune liver disease/other using validated case definitions. Annual age/sex-adjusted cirrhosis incidence rate per 100,000 person-years was calculated with incidence projection to 2040 using age-period-cohort modeling along with average annual percent change (AAPC) in cirrhosis incidence stratified by birth cohort and etiology. In total, 159,549 incident cases of cirrhosis were identified. Incidence increased by 26% with an AAPC of 2%/year (95% CI, 1.6-2.4; P < 0.001). The largest increases were for HCV (AAPC, 4.1%/year; 95% CI, 2.6-5.7; P < 0.001) and NAFLD (AAPC, 3.3%/year; 95% CI, 2.6-4.1%; P < 0.001). ALD and HCV cirrhosis in those born >1980 increased by 11.6%/year (95% CI, 9.3-13.9; P < 0.001) and 9.5%/year (95% CI, 6.2-13.0; P < 0.001), respectively. However, by 2040, cirrhosis incidence is projected to continue to increase, driven mostly by NAFLD, especially in postmenopausal women, and ALD in individuals born >1980.

CONCLUSIONS

Cirrhosis incidence will continue to increase over the next two decades secondary to NAFLD with a worrisome rapid rise in ALD cirrhosis among young adults. Public education, policy, and intervention targeting NAFLD risk factors and alcohol use in young adults are urgently needed.

Adolescent neuroimmune function and its interaction with alcohol

Adolescence is an evolutionarily conserved developmental period associated with behavioral change, including increased risk-taking and alcohol use. Experimentation with alcohol typically begins in adolescence and transitions to binge-like patterns of consumption. Alcohol exposure during adolescence can alter normative changes in brain structure and function. Understanding mechanisms by which ethanol impacts neurodevelopmental processes is important for preventing and ameliorating the deleterious consequences of adolescent alcohol abuse. This review focuses on the neuroimmune system as a key contributor to ethanol-induced changes in adolescent brain and behavior. After brief review of neuroimmune system development, acute and chronic effects of ethanol on adolescent neuroimmune functioning are addressed. Comparisons between stress/immunological challenges and ethanol on adolescent neuroimmunity are reviewed, as cross-sensitization is relevant during adolescence. The mechanisms by which ethanol alters neuroimmune functioning are then discussed, as they may portend development of neuropathological consequences and thus increase vulnerability to subsequent challenges and potentiate addictive behaviors.

Characteristics Associated With High-Intensity Binge Drinking in Alcohol Use Disorder

High-intensity binge drinking, defined as consuming 2-3 times the level of a binge (4 or 5 drinks for women or men), increases the risks of overdose and alcohol-related cancer relative to lower levels of drinking. This study examined the relationship between high-intensity binge drinking and three domains hypothesized to contribute to alcohol use disorder (AUD): incentive salience, negative emotionality, and executive function. This cross-sectional study at the National Institute on Alcohol Abuse and Alcoholism examined 429 adults with AUD and 413 adults without a history of AUD. Drinking was assessed using the 90-day Timeline Followback interview. The AUD sample was divided into training and testing sets, and a machine learning model was generated in the training set and then applied to the testing set, to classify individuals based on if they had engaged in high-intensity binge drinking. We also conducted regression models for the following dependent variables: the presence of high-intensity binge drinking, frequency of high-intensity binge drinking, and number of drinks per of binge. Independent variables in these regression models were determined by variable selection from the machine learning algorithm and included time thinking about alcohol, depression rating, and positive urgency as representative variables for the three domains. These variables were assessed using self-report measures. The models were applied to the adults without a history of AUD to determine generalizability. The machine learning algorithm displayed reasonable accuracy when classifying individuals as high-intensity binge drinkers (area under ROC=0.74, 95% CI 0.67, 0.80). In adults with AUD, greater depression rating (OR=1.04, 95% CI 1.01, 1.070) and amount of time thinking about alcohol (OR=1.48, 95% CI 1.20, 1.91) were associated with greater likelihood of high-intensity binge drinking. They were also associated with greater frequency of high-intensity binge drinking days and greater number of drinks on binge occasions. Our findings suggest that incentive salience may contribute to high-intensity binge drinking in both controls and individuals with AUD. Negative emotionality was only associated with high-intensity binge drinking in individuals diagnosed with AUD, suggesting that it may be a consequence rather than a cause of high-intensity binge drinking.