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Aims: A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy., Methods: Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous., Results: A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments., Conclusions: AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits., (© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press.)

Alcohol use disorder (AUD) is characterized by dysfunction in motivational, mood-stress regulation, and sleep systems that interact in complex ways to heighten the risk of relapse during abstinence. Emerging data suggest that excessive and chronic alcohol use disrupts sleep homeostasis and, in abstinence, subjects with AUD are known to experience insomnia that may persist for weeks to years, which we propose to refer to as insomnia associated with alcohol cessation (IAAC). The purpose of this review is to provide an update of pharmacological approaches to therapy including compounds in development, to raise awareness of the prevalence of and unmet need in IAAC and highlight differences in treatment consideration for IAAC as compared to insomnia disorder. We performed a search of select electronic databases to identify studies of pharmacological agents used to treat sleep disturbances in abstinent or treatment-seeking patients with alcohol use disorder. The search, conducted in June 2019 and updated in December 2019, yielded 1,188 abstracts after duplicates were removed, of which 36 full-text articles were assessed for eligibility. Eighteen studies were included, 15 randomized controlled trials and three open-label studies. Several classes of medications including antidepressants, anticonvulsants, and antipsychotics have been evaluated for their effectiveness in treating sleep disturbances in abstinent or treatment-seeking patients with AUD. None of these medications are approved by the FDA for the treatment of IAAC, and the currently available evidence for these agents is limited. Randomized, controlled clinical trials are warranted to evaluate the efficacy and safety of medications in the treatment of IAAC., (© 2020 Imbrium Therapeutics. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Society of Neuropsychopharmacology.)

Aims: To evaluate the long-term treatment outcome (up to 5 years) with respect to different drinking goals of patients., Methods: Alcohol-dependent individuals (n = 349) were recruited from three alcohol treatment units. They were interviewed using the Addiction Severity Index (ASI). They were sub-grouped according to their goal at treatment entry: abstinence, low- risk drinking and no decided goal., Results: Patients with abstinence as a goal at treatment entry reported at 2.5 years follow-up a higher abstinence rate, a more pronounced reduction in alcohol consumption, reduction in total number of DSM-IV criteria, higher frequency of low-risk drinking and fewer diagnoses of alcohol dependence compared to the groups who had low risk drinking as a goal or no decided goal. This improvement remained basically unchanged in all three groups at 5 years follow-up, suggesting long-term stability after the treatment interventions., Conclusions: The findings suggest that: (1) alcohol-dependent patients who have abstinence as their own drinking goal have a more favorable treatment outcome than those who have low-risk drinking as a goal or no decided goal. (2) Abstinence as a drinking goal should be considered for those who have a longer duration (for example more than 10 years) of their alcohol-related problems. (3) Patients who have no decided goal should be recommended abstinence as a drinking goal., (© The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: This paper examines: (a) change over time (2001-2013) in recently reducing or ceasing drinking in the Australian population and (b) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group., Short Summary: Rates of reducing and ceasing drinking increased between 2001 and 2013 in Australia. Young people were more likely to modify drinking due to lifestyle and enjoyment reasons; older groups were more likely to report health reasons. These trends contribute to the broader context of declining alcohol consumption in Australia., Methods: Data are from five waves of the National Drug Strategy Household Survey (N = 119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking and to predict motivations for reducing or ceasing drinking by sex and age., Results: Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007 and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons and younger people more likely to report lifestyle reasons or enjoyment., Conclusion: Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons suggest that the social position of alcohol in Australia may be shifting, particularly among young people.

Background: Non-drinking among young people has increased over the past decade in England, yet the underlying factor driving this change is unknown. Traditionally non-drinking has been found to be associated with lower socio-economic status and poorer health. This study explores among which sub-groups non-drinking has increased, and how this correlates with changes in drinking patterns, to identify whether behaviours are becoming more polarised, or reduction is widespread among young people., Methods: Among participants aged 16 to 24 years (N = 9699), within the annual cross-sectional nationally-representative Health Survey for England 2005-2015 datasets, the following analyses were conducted: 1) The proportion of non-drinkers among social-demographic and health sub-groups by year, and tests for linear trends among sub-groups, adjusting for age were calculated. In pooled analyses, an interaction between year and each variable was modelled in sex- and age-adjusted logistic regression models on the odds of being a non-drinker versus drinker 2) At the population level, spearman correlation co-efficients were calculated between the proportion non-drinking and the mean alcohol units consumed and binge drinking on the heaviest drinking day, by year. Ordinary least squares regression analyses were used, modelling the proportion non-drinking as the independent variable, and the mean units/binge drinking as the dependent variable., Results: Rates of non-drinking increased from 18% (95%CI 16-22%) in 2005 to 29% (25-33%) in 2015 (test for trend; p < 0.001), largely attributable to increases in lifetime abstention. Not drinking in the past week increased from 35% (32-39%) to 50% (45-55%) (p < 0.001). Significant linear increases in non-drinking were found among most sub-groups including healthier sub-groups (non-smokers, those with high physical activity and good mental health), white ethnicity, north and south regions, in full-time education, and employed. No significant increases in non-drinking were found among smokers, ethnic minorities and those with poor mental health. At the population-level, significant negative correlations were found between increases in non-drinking and declines in the mean units consumed (ρ = - 0.85, p < 0.001), and binge drinking (ρ = - 0.87, p < 0.001)., Conclusion: Increases in non-drinking among young people has coincided with a delayed initiation into alcohol consumption, and are to be welcomed. Future research should explore attitudes towards drinking among young people.

Aims: The goals of the current study were to identify latent classes of alcohol users among Italian emerging adults (18-33 years), examine differences in the class solution based on socio-demographic characteristics, and examine whether differences exist across classes in experiencing different types of alcohol-related negative consequences., Methods: Participants (N = 5955; 62.72% female; mean age 27.19 years) were drawn from a pre-recruited Web panel designed to be representative of the Italian young adults (18-33 years) population. Latent class analysis (LCA) was used to identify common patterns of alcohol use., Results: Four classes of drinking patterns were identified: (a) Current Nondrinkers (15%); (b) Weekend Non-Risky Drinkers (51%); (c) Weekend Risky Drinkers (20%); and (d) Daily Drinkers (13%). The number and type of classes did not differ across several demographic variables, although proportions within classes varied by sex, age, occupation status and geographic area. Weekend Risky Drinkers experienced the greatest number of alcohol-related negative consequences., Conclusions: The great majority of the sample displayed drinking patterns with relatively infrequent involvement in risky drinking. Preventive interventions should, instead, target those who drink alcohol on weekends only, but show the greatest negative consequences., Short Summary: Four classes of drinking patterns were identified in a large representative sample of Italian young adults. The great majority of the sample displayed drinking patterns with relatively little involvement in risky drinking, though those misusing alcohol at weekends were at greatest risk to experience alcohol-related negative consequences.

Background: Alcohol consumption by young people (particularly early initiation) is a predictor for poorer health in later life. In addition, evidence now clearly shows a causal link between alcohol and cancer. This study investigated prevalence, predictors of alcohol consumption among adolescents including perceptions of the link between alcohol and cancer, and the role of parents and peers., Methods: A sample of Australian school students aged 12-17 years participated in a survey (n = 2885). Logistic regression analysis was undertaken to determine predictors., Results: Alcohol use increased with age and by 16, most had tried alcohol with 33.1% of students aged 12-17 reporting that they drank at least occasionally (95% CI = 31.0-35.2). Awareness of the link between alcohol and cancer was low (28.5%). Smoking status and friends' approval were predictive of drinking, whereas parental disapproval was protective. Those aged 14-17 who did not think the link between alcohol and cancer was important were more likely to drink, as were those living in areas of least disadvantage. The only factors that predicted recent drinking were smoking and the perception that alcohol was easy to purchase., Conclusions: An education campaign highlighting the link between alcohol and cancer may have positive flow-on effects for young people, and schools should incorporate this messaging into any alcohol education programs. Consideration should be given to factors that serve to regulate under-aged accessibility of alcohol.

Aims: To examine the association between drinking levels and inpatient health service utilization in people with a lifetime diagnosis of alcohol dependence., Methods: A longitudinal prospective study was conducted in a cohort of patients with alcohol dependence who had undergone treatment in 1987. Current results refer to the association between drinking patterns at 20-year follow-up and subsequent inpatient health service utilization. At 20 years after baseline, 530 of 850 patients were alive with administrative data available. Follow-up interview was conducted on 378 patients. There were 88 refusals and 64 could not be traced. Three categories of alcohol consumption were established (abstainers, moderate drinkers and heavy drinkers) depending on the pattern of alcohol use during the last year prior to the evaluation. Health service utilization was based on official statistics, including admissions to general, rehabilitation and psychiatric hospitals. The time period analysed was 5 years after the assessment of drinking patterns., Results: Admission rates were lowest for abstainers compared to people with moderate and heavy drinking. With respect to hospital days, heavy drinking was associated with significantly higher adjusted rates than both abstainers and moderate drinkers. Alcohol-related diagnoses in hospital admissions were more frequent for both moderate and heavy drinkers., Conclusion: Abstinence and moderate alcohol consumption were both associated with lower hospitalization in people with a lifetime diagnosis of alcohol dependence. Thus, not only abstinence-oriented treatment strategies but also those to reduce alcohol intake would reduce inpatient hospitalizations., Short Summary: Abstention and reduced drinking in lifetime alcohol-dependent patients were associated with lower health care utilization compared to heavy drinking. Alcohol treatment strategies for alcohol-dependent patients have a positive impact on the reduction in health care utilization. An increase in treatment rate for alcohol use disorders will consequently have marked population health improvements., (© The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: Fibroscan ® is a non-invasive method to evaluate liver stiffness (LS), however, its accuracy in alcohol-related liver diseases (ALD) especially with respect to active or stopped alcohol drinking is largely unknown. We prospectively evaluated the LS changes in patients with ALD following alcohol withdrawal., Methods: Sixty-four patients were evaluated by FibroScan ® and lab tests at baseline and after 4 weeks of abstinence., Results: At baseline, 21 patients (33%) had an abnormal LS (> 7 kPa) and 32 patients (50%) had abnormal liver function tests. More specifically, 3 and 11 subjects had a LS higher than 9.6 kPa and 12.5 kPa, respectively. The LS significantly declined in abstinent from 9.2 ± 10.1 (M±SD) at the baseline to 6.9 ± 6.1 kPa at 4 weeks (P = 0.03), respectively, while did not change significantly in drinkers. In addition, 80% of abstainers had a significant LS reduction (-2.6 ± 5.5 kPa), compared to drinkers (2.2 ± 3.6 kPa) (P = 0.004). After 6 months, 27 patients accepted a further evaluation: 22 abstinent and 5 relapsed to drink. At the final evaluation, only 4 out of 22 abstainers had still a LS higher than 7 kPa., Conclusions: During active drinking LS is probably overestimated by Fibroscan ® in ALD, since 1 month after abstinence it is dramatically reduced, especially in subjects with baseline values higher than 7 kPa., Short Summary: We prospectively evaluated liver stiffness by Fibroscan ® in patients with alcohol-related liver disease at baseline and following abstinence. After 1 month of abstinence, the LS is dramatically reduced, especially when values are greater than 7 kPa and transaminase elevated at baseline., (© The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To study total alcohol consumption and its correlates, with an emphasis on the direction of causality., Methods: The associations among total alcohol consumption, abstaining, alcohol dependence (AD) and heavy episodic drinking were compared in 29 Organization for Economic Cooperation and Development (OECD) countries in 2010., Results: Either total alcohol consumption is determined by the number of abstainers and that of alcohol dependents, or the number of alcohol dependents is determined by total alcohol consumption. The number of non-dependent heavy episodic drinkers does not play a role., Conclusion: The number of alcohol dependents and abstainers seemingly determines total alcohol consumption and more efforts should be made to reduce AD., Short Summary: The associations between total alcohol consumption, abstaining, alcohol dependence and heavy episodic drinking were compared in 29 OECD countries in 2010. The number of non-dependent heavy episodic drinkers does not play a role. The number of alcohol dependents and abstainers seemingly determine total alcohol consumption., (© The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: Neither the predictive value of early continuous abstinence in alcohol use disorder (AUD) or the point at which this effect may emerge has been evaluated. This analysis of the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) clinical trial evaluated whether abstinence early in treatment was a predictor of longer term abstinence., Methods: Participants who stated a goal of total abstinence (N = 954) were dichotomized into Early Abstainer vs. Nonabstainers and were compared on a variety of drinking outcome measures that are frequently used in clinical trial evaluations of alcohol treatment strategies, as a function of duration of early continuous abstinence., Results: Significant differences existed for every outcome. Early Abstinence was significantly associated with fewer drinks per drinking day, number of drinking and number of heavy drinking days, and longer time to first drinking and first heavy drinking day. Effects were evident within the first week. The magnitude of all effects increased as the duration of early abstinence (1-4 weeks) increased, though the size of increase varied across the outcomes., Conclusions: These data provide evidence that drinking at the beginning of alcohol treatment is significantly and robustly associated with drinking throughout and at the end of a clinical trial treatment for AUD. Early drinking may be a useful early index to identify whether patients are responding positively to a treatment strategy, and provides a useful method for tailoring treatment to patients that is consistent with a personalized medicine approach., (© The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Folic acid, vitamins and Zinc play essential role in DNA methylation but alcohol consumption is known to affectthe levels of these micronutrients leading to risk of developing various illnesses and certain cancers. This study determinedthe levels of DNA methylation dependent-micronutrients (folate, vitamin B12, vitamin B6, zinc and selenium) andhomocysteine as a suggestion for DNA methylation status in Nigerian alcohol consumers compared with non-consumers ofalcohol. Venous blood (5ml) was obtained from thirty-four males that consume alcoholic beverages for at least 10 years andthirty-two male controls that did not consume alcoholic beverages at least 10 years. Serum concentrations of folate, vitaminB12, vitamin B6, homocysteine (Hcy), selenium (Se) and zinc (Zn) were determined using High Performance LiquidChromatography (HPLC) and Atomic Absorption Spectrophotometry (AAS) as appropriate. Independent Student t-test wasused to compare the mean values between alcohol consumers and control. Mean differences were considered significant atp<0.05. The mean serum levels of Zn and Se were significantly raised in alcohol consumers when compared with nonalcohol consumers while the mean levels of Vitamin B6 and Hcy were significantly reduced in alcohol consumers whencompared with non-alcohol consumers. There were no statistically significant differences in the mean serum levels ofVitamin B12 and folate in alcohol consumers when compared with non-alcohol consumers. Since vitamin B6 and Hcy arerequired for DNA methylation, reduced vitamin B6 and Hcy levels in consumers of alcoholic beverages might suggest DNAhypomethylation in alcohol consumers.

Aim: Non-drinkers among youth in Sweden have increased markedly during the last 15 years. The aim of this study is to investigate the temporal association between region of origin among Swedish youth and rates of non-drinking., Data and Method: Data on non-drinkers were obtained from The Swedish Council on Information and Other drugs (CAN) yearly school surveys among Swedish ninth-grade students over the period 1971-2013. Annual data of region of origin for 1968-2012 has been compiled from Statistics Sweden (SCB) and consists of all 15-year-olds in Sweden and their region of birth; Sweden, The Nordic Countries, Europe, The Middle East and the rest of the world. Autoregressive Integrated Moving Average (ARIMA) modelling was applied in order to estimate these associations., Results: Descriptive results revealed a change in the demography of Swedish 15- to 16-year-olds. In the early 1990s 1% of Swedish 15- to 16-year-olds were born in a Middle East country, this proportion increased to 6% in 2012. Furthermore, those born in the rest of the world (non-European or non-Nordic countries) increased from 1% to almost 4%. Similarly, the trend of non-drinkers increased from about 20% to more than 40% among Swedish 15- to 16-year-olds during the same period. However, a more thorough analysis using ARIMA modelling revealed no significant association between rates of region of origin and non-drinking., Conclusion: The marked increase in non-drinkers during the last 15 years is not associated to changes in the demographic composition, in terms of region of origin, among Swedish youth., (© The Author 2015. Medical Council on Alcohol and Oxford University Press.)

Aims: Although varied methods are used in estimating alcohol consumption, there has been no methodological comparison of these methods in China. The aim of this study is to compare different methods used for estimating drinking indices, such as annual per capita consumption, and proportions of risk drinking., Methods: A cross-sectional household survey using a multistage systematic sampling technique was conducted in Yunnan Province of China. The beverage-specific quantity frequency (BSQF), tri-level, last 7-day (L7D) and beverage-specific yesterday (BSY) methods were used., Results: A total of 977 subjects aged 12-35 years were surveyed. The BSQF yielded the highest annual per capita consumption (2094.2 g), followed by the tri-level (1430.8), L7D (983.0) and BSY (409.7 g) methods. The annual per drinker consumption quantities were 1762.1, 938.5, 865.7 and 493.3 g for tri-level, BSQF, L7D and BSY methods, while the proportions of high-risk drinking were 13.4, 9.4, 4.8 and 2.5%, respectively., Conclusion: The BSQF method is more suitable for measurement of annual per capita alcohol consumption in this population. The tri-level approach is a promising substitution of the graduated quantity frequency (GF) method if implemented with caution for both quantity and pattern of alcohol consumption., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: The aim of this work was to report on a heavy drinker whose azoospermia was reversed after alcohol withdrawal. We also review the literature on links between alcohol consumption and azoospermia., Method: This study is a clinical case report and a literature review., Results: Two years after alcohol withdrawal, a child was born following assisted reproduction technique. Excessive alcohol consumption (i.e. more than 60 g a day) is strongly associated with azoospermia and this condition may be reversible after alcohol withdrawal., Conclusions: Testicular biopsies should be countra-indicated for heavy drinkers, and in order to increase the chances of obtaining a pregnancy, alcohol abstinence should be encouraged in male with low-to-moderate alcohol intakes.