Tag Archives: Alcohol

A new approach to DUI

11 Aug

Human beings seem to have a hard wired desire to punish others for their transgressions. This drive might have served our ancestors well in small band level societies, but it sometimes prevents us from thinking clearly about effective social policy. In behavioral psychology we define punishment as a consequence that reduces the probability of a behavior recurring. We know a lot now about what makes punishment effective, or, as often is the case, ineffective.

Generally, our impulse to increase the severity of punishment for bad behavior has little effect on the recurrence of the undesirable behavior. This article in the Washington Post describes a much more productive approach to dealing with a very undesirable behavior, drunken driving.

Many judges across the country order abstinence as part of parole or probation, but Long decided to actually enforce it. Offenders’ drinking was monitored every single day, typically by in-person breath tests in the morning and evening. In contrast to the typically slow and unpredictable ways of the criminal justice system, anyone caught drinking faced a 100 percent chance of arrest and an immediate consequence — typically 12 to 36 hours in jail.

Recent research suggests that this approach is effective:

The results were impressive, with 24/7 Sobriety participants showing up and passing more than 99 percent of scheduled breathalyzer tests. With alcohol removed from their lives, 24/7 Sobriety participants were less likely to be re-arrested for any offense one year, two years and three years after their initial arrest. The latter two periods are particularly impressive in that individuals were typically on 24/7 Sobriety for less than a year, indicating that the benefits persisted after the program stopped. This is a favorable contrast to alcohol ignition interlocks, which typically reduce drunken driving only for the limited time they are in place on an offender’s vehicle.

Many offenders in the program had served extensive time in jail and prison, so why were they deterred by the prospect of a single night in jail? Midgette emphasizes the typical time horizon of the population, noting that “because heavy drinkers tend to heavily discount the future, deterrence depends much more on the certainty and swiftness of a sanction than its severity.”

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Even moderate alcohol consumption increases risk of cognitive decline

30 Jun

This month The British Medical Journal published a paper titled : “Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study.” Here is the abstract:

Objectives To investigate whether moderate alcohol consumption has a favourable or adverse association or no association with brain structure and function.

Design Observational cohort study with weekly alcohol intake and cognitive performance measured repeatedly over 30 years (1985-2015). Multimodal magnetic resonance imaging (MRI) was performed at study endpoint (2012-15).

Setting Community dwelling adults enrolled in the Whitehall II cohort based in the UK (the Whitehall II imaging substudy).

Participants 550 men and women with mean age 43.0 (SD 5.4) at study baseline, none were “alcohol dependent” according to the CAGE screening questionnaire, and all safe to undergo MRI of the brain at follow-up. Twenty three were excluded because of incomplete or poor quality imaging data or gross structural abnormality (such as a brain cyst) or incomplete alcohol use, sociodemographic, health, or cognitive data.

Main outcome measures Structural brain measures included hippocampal atrophy, grey matter density, and white matter microstructure. Functional measures included cognitive decline over the study and cross sectional cognitive performance at the time of scanning.

Results Higher alcohol consumption over the 30 year follow-up was associated with increased odds of hippocampal atrophy in a dose dependent fashion. While those consuming over 30 units a week were at the highest risk compared with abstainers (odds ratio 5.8, 95% confidence interval 1.8 to 18.6; P≤0.001), even those drinking moderately (14-21 units/week) had three times the odds of right sided hippocampal atrophy (3.4, 1.4 to 8.1; P=0.007). There was no protective effect of light drinking (1-<7 units/week) over abstinence. Higher alcohol use was also associated with differences in corpus callosum microstructure and faster decline in lexical fluency. No association was found with cross sectional cognitive performance or longitudinal changes in semantic fluency or word recall.

Conclusions Alcohol consumption, even at moderate levels, is associated with adverse brain outcomes including hippocampal atrophy. These results support the recent reduction in alcohol guidance in the UK and question the current limits recommended in the US.

There is a good account in The Washington Post

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The Alcohol Harm Paradox

15 May

I had not heard of this relationship before and thought my readers might be interested. The alcohol harm paradox refers to the fact that “that people with low individual or neighbourhood socioeconomic status (SES) show a greater susceptibility to the harmful effects of alcohol”

For example, in England:

Lower SES is associated with an almost two fold greater risk of alcohol related death compared with individuals in higher SES classifications.
Relative to high SES, low SES is associated with an increased risk of head and neck cancers, strokes, hypertension, liver disease and pre-term birth. These findings are independent of a number of other known risk factors for these conditions such as diet and smoking.

Here is a large study of the effect. It concludes:

Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups

It would not surprise anyone that greater wealth affords greater protection from the vicissitudes of life, but other variables may play a role, such as class differences in the patterns of drinking behavior and the beverages consumed.

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Testing a hypothesis: Over 21 edition

24 Apr

Tonight, I am going to lecture about hypothesis testing. I plan to show my students this video I found on BoingBoing:

The question for the students: was this a fair test?

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“Do ‘Moderate’ Drinkers Have Reduced Mortality Risk?”

30 Mar

Not according to this meta-analysis published in  The Journal of Studies on Alcohol and Drugs.

“In summary, analyses of groups of higher quality studies free from abstainer biases were less likely to find evidence of reduced risk of mortality (i.e., health benefits) at low levels of alcohol consumption. Rather, the pattern of results is more consistent with a linear dose response than a J-shaped curve describing the risk relationships between level of alcohol consumption and all-cause mortality.”

 

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IQ and Alcohol Consumption

1 Mar

A paper published in Alcoholism: Clinical and Experimental Research:

“Background
Studies of the association between IQ and alcohol consumption have shown conflicting results. The aim of this study was to investigate the association between IQ test results and alcohol consumption, measured as both total alcohol intake and pattern of alcohol use.

Methods
The study population consists of 49,321 Swedish males born 1949 to 1951 who were conscripted for Swedish military service 1969 to 1970. IQ test results were available from tests performed at conscription. Questionnaires performed at conscription provided data on total alcohol intake (consumed grams of alcohol/wk) and pattern of drinking. Multinomial and binomial logistic regressions were performed on the cross-sectional data to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Adjustments were made for socioeconomic position as a child, psychiatric symptoms and emotional stability, and father’s alcohol habits.

Results
We found an increased OR of 1.20 (1.17 to 1.23) for every step decrease on the stanine scale to be a high consumer versus a light consumer of alcohol. For binge drinking, an increased OR of 1.09 (95% CI = 1.08 to 1.11) was estimated for every step decrease on the stanine scale. Adjustment for confounders attenuated the associations. Also, IQ in adolescence was found to be inversely associated with moderate/high alcohol consumption measured in middle age.

Conclusions
We found that lower results on IQ tests are associated with higher consumption of alcohol measured in terms of both total alcohol intake and binge drinking in Swedish adolescent men.”

Ironically the account of this study in The Telegraph linked to this story:

Starbucks to offer wine and beer in evenings

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How effective is Alcoholics Anonymous?

26 Dec

Researchers have long questioned the effectiveness of Alcoholics Anonymous. Most of the claims made on its behalf are anecdotal and, thus, of little scientific value. Research has been hampered by the lack of randomized control trials. This type of analysis is especially important. Without it, one could not rule out the possibility that people who have had success with AA were self selected and it was some characteristic of those individuals that caused their success and not the AA program.

Recent research, however, casts new light on AA and suggests that the program itself might be effective. Here is a summary by Keith Humphreys. And here is his paper. From its conclusion:

“For most individuals seeking help for alcohol problems, increasing AA attendanceleads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selec-tion. However, for populations with high preexisting AA involvement, further increases in AA atten-dance may have little impact.”

Humphreys also has this piece in The Washington Post:

‘Studies such as these dramatically reduced the ranks of AA critics among scientists. AA’s value is still questioned in a few quarters, but as Harvard Professor of Psychiatry John Kelly notes, this is becoming less true as the years go by: “The stronger scientific evidence supporting the effectiveness of AA is relatively new. It takes time for evidence to disseminate into clinical practice as well as into broader society.”’

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Ten percent of drinkers consume more than half of all alcohol

29 Oct

Alcohol is America’s most serious drug problem. Contrary to industry propaganda, there is no known safe level of alcohol consumption. The health benefits claimed for alcohol do not survive critical scrutiny.

The Washington Post reports

“the top 10 percent of drinkers account for well over half of the alcohol consumed in any given year.”

According to Stanford researcher Philip J. Cook:

“One consequence is that the heaviest drinkers are of greatly disproportionate importance to the sales and profitability of the alcoholic-beverage industry,” he writes writes. “If the top decile somehow could be induced to curb their consumption level to that of the next lower group (the ninth decile), then total ethanol sales would fall by 60 percent.”

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Hat tip to BoingBoing.

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Light drinking increases cancer risks

9 Oct

Dr. Mirkin’s Fitness and Health e-Zine alerts us to a recent meta-analysis of research on the health effects of drinking published in the Annals of Oncology.

There is good reason to doubt the widely repeated claim that moderate drinking has health benefits. According to the meta-analysis:

“Light drinking increases the risk of cancer of oral cavity and pharynx, esophagus and female breast.”

Dr. Mirkin points out:

“For many years the wine, beer and alcoholic beverage industries have promoted studies showing that alcohol is healthful. However, researchers at the University of Victoria in British Columbia reviewed 54 studies and found that only seven of those studies corrected their non-drinking population for people who had been told to stop drinking for health reasons (Addiction Research and Theory, April 2006).

When researchers perform an epidemiological study to see if alcohol prevents disease, they compare people who drink with those who do not drink. However, many people do not drink because their doctors have told them they have liver, heart or kidney disease, high blood pressure, alcoholism, stomach ulcers, or other major health problems. The Canadian researchers re-analyzed 47 studies that associated wine or other alcohol with a longer life and decreased risk for heart attacks. When the studies were corrected to remove the people who had been ordered to stop drinking for health reasons, they found no difference in death rate between moderate drinkers and those who do not drink at all. Always be skeptical of studies that say alcohol prolongs life.”

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