Daily Archives: 24/10/2015

This was an interesting report published by the American Association of Pediatrics stating that children should be educated about the dangers of alcohol from the age of 9. This is particularly close to home for me as my eldest son is 9 years old …….

Given the high prevalence of binge drinking among adolescents, parents and pediatricians should talk to children about the dangers of alcohol use from the age of 9 years. This is according to a clinical report from the American Academy of Pediatrics.

Co-authored by Dr. Lorena Siqueira, clinical professor of pediatrics at Florida International University and member of the American Academy of Pediatrics (AAP) Committee of Substance Abuse, the report is published in the journal Pediatrics.

Alcohol use among children and adolescents has become a major concern in the US. According to the AAP report, around 21% of adolescents have had at least one sip of alcohol before the age of 13, with almost 80% having done so by 12th grade.

In addition, the report notes that around 36-50% of high school students drink alcohol, with 28-60% reporting binge drinking. Of these, almost two-thirds report binge drinking on at least one occasion in the past 30 days.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) define binge drinking as a “pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL,” which normally occurs after the consumption of four alcoholic beverages within 2 hours for women and five or more drinks within 2 hours for men.

However, Dr. Siqueira and colleagues note that because children and teenagers typically weigh less than adults, it is likely to take less alcohol to reach unsafe BAC levels.

Children ‘start to think positively about alcohol’ from the age of 9

Three or more alcoholic beverages in 2 hours is considered binge drinking among girls aged 9-17 and boys aged 9-13, according to the report authors. For boys aged 14-15, four or more drinks in 2 hours is defined as binge drinking, rising to five or more drinks in 2 hours for boys aged 16-17.

“Given their lack of experience with alcohol and smaller bodies, children and adolescents can have serious consequences – including death – with their first episode of binge drinking,” says Dr. Siqueira.

“Studies have indicated that continued alcohol use during this growth period can interfere with important aspects of brain development that can lead to cognitive impairment, alcohol-induced brain damage and substance use disorders later in life,” she adds.

What is more, Dr. Siqueira points out that adolescents who engage in binge drinking are more likely to engage in risky behaviors – such as drunk driving – and have higher rates of suicide.

“As with most high-risk behaviors, early prevention proves to be more effective than later intervention,” she notes. As such, the report authors say both pediatricians and parents should be aware of the dangers alcohol use can pose to children and teenagers and recommend that they communicate these risks to children from the age of 9 years.

Explaining the reasons for their recommendation, the authors say:

“Surveys indicate that children start to think positively about alcohol between ages 9 and 13 years. The more young people are exposed to alcohol advertising and marketing, the more likely they are to drink, and if they are already drinking, this exposure leads them to drink more.

Therefore, it is very important to start talking to children about the dangers of drinking as early as 9 years of age.”

Guidelines for pediatricians

The report suggests pediatricians should inform parents about the key role they play in their child’s alcohol use, pointing to a 2013 study that found parental communication about alcohol use before children went to college reduced the likelihood of heavy drinking in adolescence by 20 times.

In addition, the authors say pediatricians should assess all adolescents for alcohol use using “structured screening instruments.”

They recommend the use of a screening tool created by the AAP and NIAAA consisting of two questions that vary by age group. For children aged 9-11, for example, the tool would ask: “Do you have any friends who drank beer, wine, or any drink containing alcohol in the past year?” and “How about you – have you ever had more than a few sips of beer, wine, or any drink containing alcohol?”

“This very brief screen can detect risk early, is empirically based, and is a good predictor of current and future negative consequences of alcohol use,” say the authors.

While adolescent drinking remains a key concern in the US, a report from the Substance Abuse and Mental Health Services Administration (SAMHSA) released in June found the rate of alcohol use among youths aged 12-20 drinking has reduced significantly over the past decade, falling from 28.8% in 2002 to 22.7% in 2013.

I find that an impressive statistic – parental communication reducing likelihood of heavy drinking by 20 times but equally am not sure about using a screening tool with my own children. As a professional seeing children it would be appropriate.

My two haven’t seen us drinking for 2 years so since my eldest was 7 and even before then most of our drinking was done once they were in bed. I’m really hoping that this non-alcohol consumption role-modelling has been a good grounding for them and they do ask questions about our NA beer so we’ve had brief conversations with them both already. If I need to step it up a gear that’s fine by me 🙂 What do you think?

This research was published on the Medical Express website in September this year and was reporting on the fact that the neuron responsible for alcoholism had been found.

This finding would be representative of the genetic/physiological model or integrative bio-psycho-social model (which is my preferred approach) of understanding addiction.

Scientists have pinpointed a population of neurons in the brain that influences whether one drink leads to two, which could ultimately lead to a cure for alcoholism and other addictions.

A study, published in the Journal of Neuroscience by researchers at the Texas A&M Health Science Center College of Medicine, finds that alcohol consumption alters the structure and function of neurons in the dorsomedial striatum, a part of the brain known to be important in goal-driven behaviors. The findings could be an important step toward creation of a drug to combat alcoholism.

“Alcoholism is a very common disease,” said Jun Wang, M.D., Ph.D., the lead author on the paper and an assistant professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine, “but the mechanism is not understood very well.”

Now, Wang and his team have helped come a little closer to that understanding. Using an animal model, the researchers determined that alcohol actually changes the physical structure of medium spiny neurons, the main type of cell in the striatum. These neurons can be thought of like a tree, with many branches, and many small protrusions, or spines, coming off of them. They each have one of two types of dopamine receptors, D1 or D2, and so can be thought of as either D1 or D2 neurons. D1 neurons are informally called part of a “go” pathway in the brain, while D2 neurons are in the “no-go” pathway. In other words, when D2 neurons are activated, they discourage action—telling you to wait, to stop, to do nothing.

Although it is well known that the neurotransmitter dopamine is involved in addiction, this study goes further, showing that the dopamine D1 receptor also plays an important role in addiction. The team found that periodic consumption of large amounts of alcohol acts on D1 neurons, making them much more excitable, which means that they activate with less stimulation.

“If these neurons are excited, you will want to drink alcohol,” Wang said. “You’ll have a craving.” That is to say, when neurons with D1 receptors are activated, they compel you to perform an action—reaching for another bottle of tequila, in this case. This then creates a cycle, where drinking causes easier activation, and activation causes more drinking.

These changes in activation of D1 neurons might be related to the physical changes happening at the sub-cellular level in brains that have been exposed to alcohol. They have longer branching and more of the mature, mushroom-shaped spines—the type that stores long-term memories—than their abstaining counterparts.

Conversely, the placebo group, the ones not exposed to alcohol, tended to have more of the immature versions of the mushroom-shaped spines in D1 neurons of their brains. The total number of spines didn’t change in the two groups, but the ratio between mature and immature was dramatically different between the alcohol group and the placebo group. This has important implications for memory and learning in drug addiction.

“When you drink alcohol, long-term memory is enhanced, in a way,” Wang said. “But this memory process is not useful—in fact, it underlies addiction since it affects the ‘go’ neurons.” Because there was no difference in the number of each type of spine in the D2 (no-go) neurons of alcohol-consuming and control models, the researchers realized there was a specific relationship between D1 neurons and alcohol consumption.

“We’re now able to study the brain at the neuron-specific and even spine-specific level,” Wang said.

How do you determine which neuron, which type of neurons or which group of neurons is responsible for a specific disease? That’s what the next part of the study tried to answer.

The alcohol-consuming animal models with the increased mature spines in D1 neurons also showed an increased preference to drink large quantities of alcohol when given the choice.

Furthermore, and perhaps most excitingly, when those same animal models were given a drug to at least partially block the D1 receptor, they showed much-reduced desire to drink alcohol. However, a drug that inhibited the D2 dopamine receptors had no effect. “If we suppress this activity, we’re able to suppress alcohol consumption,” Wang said. “This is the major finding. Perhaps in the future, researchers can use these findings to develop a specific treatment targeting these neurons.”

The study, which was co-authored with researchers from the University of California San Francisco, was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“My ultimate goal is to understand how the addicted brain works,” Wang said, “and once we do, one day, we’ll be able to suppress the craving for another round of drinks and ultimately, stop the cycle of alcoholism.”

Any research that helps us understand further what is going on in the brain when cravings are triggered is a good thing as far as I’m concerned although I’m wary of relying too heavily on only the medical model to explain alcoholism or addiction more generally as this is a reductionist approach and the issue is more complex than that. What are your thoughts?

PS I seem to have gone a bit bonkers this week-end and have two posts queued up for both today and tomorrow. I would rejig things to spread them out but I’m dropping to posting every other day in November and that’ll completely throw that out of kilter! I tell you what it’s my birthday on Monday so consider the extras an early birthday sober treat 😉