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Recently, a meta‐analysis of randomized controlled trials (RCTs) on utilization of substance abuse services following brief alcohol interventions in general health‐care settings by Glass et al. 1 has been published in Addiction.The authors aimed to estimate the main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care. To identify RCTs, the authors performed a systematic review of English‐language papers published in three electronic databases to 2013. Inclusion of studies was not limited to any specific country. Thirteen RCTs met the inclusion criteria and nine RCTs were included in the analysis (n = 993 and n = 937 intervention and control group participants, respectively). The meta‐analysis retrieved no statistically significant results, even in subgroup analyses of the studies based on study characteristics (i.e. age, setting, intervention intensity and population severity), or when studies on referral‐specific interventions were solely considered. Given their findings, the authors have concluded that there is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services.In light of the existing literature, the reading of this manuscript raises two main comments.First the authors reported that they performed a systematic review in MEDLINE, PsycINFO and CNIAHL Plus to July 2013. The authors also stated that although there was no evidence for publication bias, their hand search to identify grey literature could have missed unpublished reports. Because RCTs with positive results tend to be published, the authors concluded it was unlikely that their findings would be altered substantively by unidentified unpublished research. However, the search and screening processes of their systematic review did not apparently identify three RCTs on referral‐specific interventions. Two of these three RCTs are indexed in MEDLINE and/or in PsycINFO (Apodaca et al., 2007 2; Liu et al., 2011 3), and one is an unpublished report (Runge et al., 2002 4). All three RCTs exhibited favourable findings for the effectiveness of brief interventions in increasing subsequent alcohol treatment utilization.For instance, the RCT by Runge et al. [4] (n = 388) showed that brief advice could increase significantly receipt of specialist evaluation for further treatment at 6 months by injured patients from two emergency departments compared with an inactive control condition [19.2% compared with 4.5%; odds ratio (OR) = 5.1, 95% confidence interval (CI) = 2.1–12.2]. The RCT by Apodaca et al. [2] reported an increase in further treatment‐seeking at 5 months among a sample of in‐patients from a trauma centre with a mean Alcohol Use Disorders Identification Test (AUDIT) score of 20 for brief advice, compared with the control group [6 of 15 (40%) versus two of 15 (13%)], but this increase was not found statistically significant given the small sample size (n = 40). The study by Liu et al. [3] (n = 616) also reported that brief intervention with post‐discharge sessions was associated significantly with treatment utilization at 12 months in in‐patients from medical/surgical wards [8.3 versus 2.1%, P = 0.01 (OR) = 4.2, 95%, CI = 1.4–12.4)].Given the positive findings for alcohol treatment utilization after alcohol interventions reported by these three RCTs, and considering their sample size, including them in the analysis may have yielded different results.In addition, as discussed by the authors, most included RCTs discarded dependent drinkers and/or mainly recruited hazardous and harmful drinkers for whom referral to treatment is not necessarily required. Given that brief interventions target individuals with a broad range of alcohol use severity, focusing on the most severe stages of alcohol misuse may be the most valid approach to evaluating the efficacy of brief alcohol intervention in increasing the receipt of alcohol‐related services 5, 6.

BACKGROUND: This commentary discusses the importance of the recent article by Suffoletto and colleagues (in press), from the perspective of the developing role that technology such as text-messaging is serving as a means of increasing the reach of brief interventions for harmful alcohol use. RESULTS: This study is important as it offers evidence from a well-designed study that text-messaging can be used to survey young adults about their alcohol use shows promising results for the potential efficacy of this technology to reduce alcohol use, including risky heavy episodic use. There are ethical and clinical considerations around text-messaging that need to be examined. CONCLUSIONS: Future adequately powered randomized studies are needed to show the comparative effect of new technologies, such as text-messaging, in comparison with more traditional methods of providing interventions in reducing harmful alcohol use. Language: en

Background problem alcohol use is common among problem drug users (PDU) and associated with adverse health outcomes. Primary care has an important role in the overall stepped approach to alcohol treatment, especially screening and brief intervention (SBI). Aim To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care. Methods material for this discussion paper was gathered from three biomedical databases (PubMed, PsycINFO and Cochrane library), conference proceedings and online resources of professional organisations or national health agencies. Themes discussed in this paper are: (a) the potential of primary care for delivery of alcohol SBIs to PDUs, (b) screening methods and (c) application of brief interventions to PDUs. Although SBI improves health outcomes associated with problem alcohol use in the general population, further research is needed among high-risk patient groups, especially PDUs. Health Research Board 12M embargo - release after 24/08/2012 - AV 21/10/2011 au, ke, ab - kpw10/11/11 Embargo update in line with published version - OR 22/02/2013

The objective of this study was to conduct a preliminary evaluation of an Internet-based intervention for problem drinkers, comparing changes in drinking between respondents who only received the intervention to those who also received a self-help book. After receiving a personalized feedback summary on the Internet, 83 respondents provided complete baseline information and volunteered to participate in a 3-month follow-up survey. Half of the respondents were randomized to receive an additional self-help book. The follow-up was returned by 48 respondents (69% female). Repeated measures ANOVAs were conducted to compare drinking levels at baseline and 3-month follow-up among respondents who only received the Internet-based intervention. There was minimal support for an impact of the Internet intervention alone. In addition, hierarchical regression analyses were conducted to compare respondents in the two intervention conditions on their drinking at follow-up, controlling for baseline consumption. Respondents who received the additional self-help book reported drinking less and experiencing fewer consequences at follow-up as compared to respondents who received only the Internet-based intervention. While the results are promising, they cannot be taken as evidence of the efficacy of Internet-based personalized feedback as a stand-alone intervention because of the absence of a control group that did not receive the intervention. Further research on this topic should be a priority because of the potential for Internet-based interventions to reach problem drinkers underserved by traditional treatment.

Introduction Harms from intimate partners' (IP) drinking range from frustration because the partner has not performed their role to assault. Aim To describe the prevalence and persistence of alcohol‐related harms to IPs and assess which respondents are more likely to report discontinuation of this harm. Design and methods Cross‐sectional (n = 2649) and follow‐up (n = 1106) alcohol's harm to others telephone surveys in 2008 and 2011 (response rates of 35% and 15% of the original sample respectively) were used to elicit harms to respondents from their IP's drinking (by gender and relationship). To examine discontinuation, a sub‐sample of 83 respondents was analysed in detail. Results A total of 6.7% of Australians were negatively affected by an IP's drinking in 2008. Women were more likely to report harm than men from an IP's drinking. Of the 1106 respondents who completed both surveys, the majority (90%) reported no harm from IPs although 3% reported harm in both surveys. No significant correlates of discontinuation of harm were identified. Discussion Many Australian relationships are affected in a range of ways because of the drinking of their IPs. A minority of respondents were affected by their IP's drinking, yet over half (57%) of those harmed in 2008 continued to experience harm in 2011. Additionally, half (46.9%) of those who were not harmed in 2008 but did live with a heavy drinking IP did go on to be harmed in 2011. More research on the role of alcohol‐related harm from IPs with larger samples is required to examine predictors of change. [Laslett A‐M, Jiang H, Room R. Alcohol's involvement in an array of harms to intimate partners. Drug Alcohol Rev 2017;36:72–79]

Purpose The substantial and unexpected increase in “deaths of despair” in the US (e.g., deaths from drug overdose, suicide, and alcohol-related liver diseases) reported by economists Case and Deaton in 2015 raises questions about the number and characteristics of US adults potentially living “lives of despair” with these problems. Methods We used data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to examine population estimates and characteristics of adults with lifetime history of substance use disorder (SUD) and suicide attempt, or either condition alone, as compared to those with neither. Results An estimated 7.2 million adults had both lifetime SUD and suicide attempt and 78.8 million had either. Those with both faced far more psychosocial adversities, familial adverse experiences and psychiatric disorders compared to those with the other two groups, and reported greater mental health service utilization. Multivariable analysis showed that psychiatric multimorbidity and violence were the strongest correlates of having both conditions as compared to neither while those with either condition fell in between. Conclusion A substantial number of US adults live with a lifetime SUD and suicide attempt with a multiplicity of additional socioeconomic, psychiatric and familial problems. While their utilization of mental health care service exceeds those with either or neither conditions, quality of life remained much poorer, suggesting that mental health treatment alone may not be enough to mitigate their sufferings, and a combination of both social policy support and quality mental health care may be needed.

Introduction and Aims Liquor permits were once used throughout Scandinavia and North America for managing alcohol, but largely disappeared in the late 20th century. Today, they are used in some Indigenous communities in Nunavut, Canada and the Northern Territory, Australia. This paper examines the extent to which liquor permits: (i) contribute to reducing alcohol‐related harms in Indigenous communities; and (ii) offer a viable mechanism for managing alcohol in Indigenous communities. Design and Methods The study draws on published and unpublished international literature on liquor permit systems in Indigenous communities, and on field visits to northern territory (NT) communities. Results Apart from one anecdotal report, the study found no evidence that liquor permit systems in Nunavut communities have reduced alcohol‐related problems. In the NT, they have reduced alcohol‐related harms in some communities. However, management of liquor permit systems generates significant administrative demands in communities. Discussion and Conclusions Effectiveness of liquor permit systems is a product of five factors: permits themselves; agencies and procedures for issuing and managing permits; agencies and procedures for supplying liquor; enforcement of permit conditions, and the presence of other agencies—legal and illegal—affecting supply and consumption of liquor. Liquor permits continue to be valued by some Indigenous communities for managing alcohol. This study suggests that they can do so provided: (i) agencies administering permits have adequate support; (ii) controls over non‐legal purchasing and consumption of liquor are effective, and (iii) the permit system is viewed in the community as legitimate, equitable and transparent.

Introduction and Aims Gender and age patterns of drinking are important in guiding country responses to harmful use of alcohol. This study undertook cross‐country analysis of drinking across gender, age groups in some high‐and middle‐income countries. Design and Methods Surveys of drinkers were conducted in Australia, England, Scotland, New Zealand, St Kitts and Nevis (high‐income), Thailand, South Africa, Mongolia and Vietnam (middle‐income) as part of the International Alcohol Control Study. Drinking pattern measures were high‐frequency, heavier‐typical quantity and higher‐risk drinking. Differences in the drinking patterns across age and gender groups were calculated. Logistic regression models were applied including a measure of country‐level income. Results Percentages of high‐frequency, heavier‐typical quantity and higher‐risk drinking were greater among men than in women in all countries. Older age was associated with drinking more frequently but smaller typical quantities especially in high‐income countries. Middle‐income countries overall showed less frequent but heavier typical quantities; however, the lower frequencies meant the percentages of higher risk drinkers were lower overall compared with high‐income countries (with the exception of South Africa). Discussion and Conclusions High‐frequency drinking was greater in high‐income countries, particularly in older age groups. Middle‐income countries overall showed less frequent drinking but heavier typical quantities. As alcohol use becomes more normalised as a result of the expansion of commercial alcohol it is likely frequency of drinking will increase with a likelihood of greater numbers drinking at higher risk levels.

Background Anxiety and alcohol use disorders are common and disabling conditions that people typically endure for many years before accessing treatment. The link between anxiety and alcohol use is well-established, with these issues commonly emerging and/or escalating during emerging adulthood. This randomized controlled trial evaluated a psychologist-supported, web-based intervention, designed with and for emerging adults, that aims to promote adaptive coping strategies, and prevent anxiety and alcohol use from progressing to chronic, mutually-reinforcing disorders. Methods Between December 2017 and September 2018, 123 emerging adults (aged 17–24) reporting anxiety symptoms and hazardous alcohol use were randomized to receive the Inroads or control (assessment plus alcohol information) intervention. The Inroads program combined five web-based cognitive behavioral therapy modules with weekly psychologist support via email/phone. Primary outcomes were alcohol consumption, severity of alcohol-related consequences, and general anxiety symptoms, assessed at baseline, 2 and 6-months post-baseline. Secondary outcomes included hazardous alcohol use and social anxiety. Trial Registration: Prospectively registered in the Australian New Zealand Clinical Trials Registry, ACTRN12617001609347. Findings Alcohol consumption and associated consequences reduced in both groups, with the Inroads group reporting greater alcohol reductions by 6-month follow-up (mean difference -0.74, 95% CI: -1.47 to -0.01, d = 0.24). Relative to controls, hazardous alcohol use reduced among Inroads participants at both follow-ups (2-month mean difference -2.14, 95% CI: -4.06 to -0.22). Inroads participants also reported reduced symptoms of general (mean difference -3.06, 95% CI: -4.97 to -1.15, d = 0.88) and social anxiety (mean difference -3.21, 95% CI: -6.34 to -0.07, d = 0.32) at 2-month follow-up, with improvements in social anxiety sustained at 6-months. Interpretation The Inroads program demonstrated beneficial effects on alcohol consumption, hazardous alcohol use, and anxiety symptoms. The web-based format is aligned with youth treatment preferences and can be delivered at scale to achieve wide dissemination and reduce the significant burden associated with these chronic, mutually reinforcing conditions. Funding Australian Rotary Health, Australian National Health and Medical Research Council.

Background Acupuncture has been used as a potential therapy for alcohol withdrawal syndrome (AWS), but evidence for its effects on this condition is limited. Objective To assess the effects and safety of acupuncture for AWS. Data sources Central Register of Controlled Trials (CENTRAL), PubMed, Embase, the Cochrane Library, PsycINFO, Chinese Biomedicine Literature (CBM), China National Knowledge Infrastructure (CNKI) and Wan-Fang Database were searched from their inception to August 2016. Study eligibility criteria Randomised controlled trials (RCTs) of drug plus acupuncture or acupuncture alone for the treatment of AWS were included. Data collection and analysis Continuous data were expressed as mean difference (MD) with 95% confidence intervals (95% CI). Dichotomous data were expressed as risk ratio (RR) with 95% CI. Results Eleven RCTs with 875 participants were included. In the acute phase, two trials reported no difference between drug plus acupuncture and drug plus sham acupuncture in the reduction of craving for alcohol; however, two positive trials reported that drug plus acupuncture was superior to drug alone in the alleviation of psychological symptoms. In the protracted phase, one trial reported acupuncture was superior to sham acupuncture in reducing the craving for alcohol, one trial reported no difference between acupuncture and drug (disulfiram), and one trial reported acupuncture was superior to sham acupuncture for the alleviation of psychological symptoms. Adverse effects were tolerable and not severe. Conclusion There was nosignificant difference between acupuncture (plus drug) and sham acupuncture (plus drug) with respect to the primary outcome measure of craving for alcohol among participants with AWS, and no difference in completion rates (pooled results). There was limited evidence from individual trials that acupuncture may reduce alcohol craving in the protracted phase and help alleviate psychological symptoms; however, given concerns about the quantity and quality of included studies, further large-scale and well-conducted RCTs are needed. Protocol registration PROSPERO CRD42016039862.

Alcohol misuse has been associated with negative consequences among HIV-positive patients. Data on real prevalence of risky alcohol consumption among the HIV-positive population in the UK are lacking. A cross-sectional questionnaire study using standardised validated instruments among HIV-positive (n = 227) and HIV-negative (n = 69) patients was performed. The prevalence of risky alcohol consumption (AUDIT) and associations with depressive symptoms (PHQ-9), problematic drug use (DUDIT), adherence to ART (CASE Adherence Index), sexual behaviour and demographic characteristics were assessed among both patient groups independently. A quarter (25.1%) of HIV-positive patients and 36.1% of HIV-negative patients reported risky alcohol consumption (AUDIT-score ≥ 8). In the multivariable analysis among HIV-positive patients depressive symptoms (p = 0.03) and problematic drug use (p = 0.007) were associated with risky alcohol consumption. Among HIV-negative patients these associations were not present. Risky alcohol consumption among HIV-positive patients is prevalent, and together with depressive symptoms and problematic drug use, may influence HIV-disease progression and patients’ wellbeing. Electronic supplementary material The online version of this article (10.1007/s10461-019-02714-2) contains supplementary material, which is available to authorized users.

Introduction and Aims This study examines the proportion of alcohol markets consumed in harmful drinking occasions in a range of high‐, middle‐income countries and assesses the implications of these findings for conflict of interest between alcohol producers and public health and the appropriate role of the alcohol industry in alcohol policy space. Design and Methods Cross‐sectional surveys were conducted in 10 countries as part of the International Alcohol Control study. Alcohol consumption was measured using location‐ and beverage‐specific measures. A level of consumption defined as harmful use of alcohol was chosen and the proportion of the total market consumed in these drinking occasions was calculated for both commercial and informal alcohol. Results In all countries, sizeable proportions of the alcohol market were consumed during harmful drinking occasions. In general, a higher proportion of alcohol was consumed in harmful drinking occasions by respondents in the middle‐income countries than respondents in the high‐income countries. The proportion of informal alcohol consumed in harmful drinking occasions was lower than commercial alcohol. Discussion and Conclusions Informal alcohol is less likely to be consumed in harmful drinking occasions compared with commercial alcohol. The proportion of commercial alcohol consumed in harmful drinking occasions in a range of alcohol markets shows the reliance of the transnational alcohol corporations on harmful alcohol use. This reliance underpins industry lobbying against effective policy and support for ineffective approaches. The conflict of interest between the alcohol industry and public health requires their exclusion from the alcohol policy space.

Introduction and Aims A 2010 World Health Assembly resolution called on member states to intensify efforts to address alcohol‐related harm. Progress has been slow. This study aims to determine the magnitude of public support for 12 alcohol policies and whether it differs by country, demographic factors and drinking risk (volume consumed). Design and Methods Data are drawn from seven countries participating in the International Alcohol Control Study which used country‐specific sampling methods designed to obtain random, representative samples. The weighted total sample comprised 11 494 drinkers aged 16–65 years. Results Drinking risk was substantial (24% ‘increased’ risk and 16% ‘high’ risk) and was particularly high in South Africa. Support varied by alcohol policy, ranging from 12% to 96%, but was above 50% for 79% of the possible country/policy combinations. Across countries, policy support was generally higher for policies addressing drink driving and increasing the alcohol purchase age. There was less support for policies increasing the price of alcohol, especially when funds were not earmarked. Policy support differed by country, and was generally higher in the five middle‐income countries than in New Zealand. It also differed by age, gender, education, quantity/frequency of drinking, risk category and country income level. Discussion and Conclusions We found a trend in policy support, generally being highest in the low–middle‐income countries, followed by high–middle‐income countries and then high‐income countries. Support from drinkers for a range of alcohol policies is extensive across all countries and could be used as a catalyst for further policy action.

Introduction and Aim To report data on the implementation of alcohol policies regarding availability and marketing, and drink driving, along with ratings of enforcement from two small high‐income to three high‐middle income countries, and one low‐middle income country. Method This study uses the Alcohol Environment Protocol, an International Alcohol Control study research tool, which documents the alcohol policy environment by standardised collection of data from administrative sources, observational studies and interviews with key informants to allow for cross‐country comparison and change over time. Results All countries showed adoption to varying extents of key effective policy approaches outlined in the World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (2010). High‐income countries were more likely to allocate resources to enforcement. However, where enforcement and implementation were high, policy on availability was fairly liberal. Key Informants judged alcohol to be very available in both high‐ and middle‐income countries, reflecting liberal policy in the former and less implementation and enforcement and informal (unlicensed) sale of alcohol in the latter. Marketing was largely unrestricted in all countries and while drink‐driving legislation was in place, it was less well enforced in middle‐income countries. Conclusion In countries with fewer resources, alcohol policies are less effective because of lack of implementation and enforcement and, in the case of marketing, lack of regulation. This has implications for the increase in consumption taking place as a result of the expanding distribution and marketing of commercial alcohol and consequent increases in alcohol‐related harm.

The information–motivation–behavioral skills (IMB) model is useful for understanding sexual risk behavior, but has not been tested with hazardously-drinking sexually transmitted infection (STI) clinic patients, a subpopulation at greater HIV risk, or with a network-perspective sexual risk behavior outcome. Participants (N = 569) were STI clinic patients who screened positive for hazardous drinking and risky sexual behavior. Sexual risk behavior (SRB) was operationalized as a latent variable with three indicators: (1) number of sexual partners, (2) number of unprotected sex occasions with primary partner, and (3) number of unprotected sex occasions with non-primary partner(s). Preliminary analyses suggested SRB was best operationalized as a latent variable with two indicators, while unprotected sex with primary partners should be considered separately. In structural models with good fit, the IMB model was generally supported. The IMB model functioned differently for non-primary and multiple partners compared to primary partners in STI clinic patients with hazardous alcohol use.

Background: The maintenance of harmful alcohol use can be considered a reiterated decision in favour of alcohol in concrete drinking occasions. These decisions are often made despite an intention to quit or reduce alcohol consumption. We tested if a hyperactive reward system and/or an impaired cognitive control system contribute to such unfavourable decision-making. Methods: In this fMRI study, men with modest to harmful drinking behaviour, which was measured using the Alcohol Use Disorders Identification Test (AUDIT), repeatedly made decisions between alcoholic and nonalcoholic drinks. Based on prior individual ratings, decision pairs were created with an alcoholic decision option considered more desirable but less beneficial by the participant. By correlating AUDIT scores with brain activation during decision-making, we determined areas explicitly related to pro-alcohol decisions in men with greater drinking severity. Results: Thirty-eight men participated in our study. Behaviourally, we found a positive correlation between AUDIT scores and the number of decisions for desired alcoholic drinks compared with beneficial nonalcoholic drinks. The fMRI results show that AUDIT scores were positively associated with activation in areas associated with reward and motivation processing (i.e., ventral striatum, amygdala, medial prefrontal cortex) during decisions favouring a desired, nonbeneficial alcoholic drink. Conversely, we did not find hypoactivation in areas associated with self-control (dorsolateral prefrontal cortex). These effects were not present when participants chose a desired, nonbenefical, nonalcoholic drink. Limitations: The men participating in our study had to be abstinent and would potentially consume an alcoholic drink at the end of the experiment. Hence, we did not define manifest alcohol dependence as an inclusion criterion and instead focused on less severely affected individuals. Conclusion: Our results indicate that with growing drinking severity, decisions for alcoholic drinks are associated with increasing activity in reward-associated neural systems, rather than decreasing activity in self-control–associated systems.

// Niloufar Safinia 1,* , Trishan Vaikunthanathan 1,* , Henrieta Fraser 1 , Sarah Thirkell 1 , Katie Lowe 1 , Laura Blackmore 2 , Gavin Whitehouse 2 , Marc Martinez-Llordella 2 , Wayel Jassem 2 , Alberto Sanchez-Fueyo 2 , Robert I. Lechler 1 and Giovanna Lombardi 1 1 MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, King’s College London, Guy’s Hospital, London, UK 2 Institute of Liver Studies, King’s College Hospital, London, UK * Co-first author Correspondence to: Niloufar Safinia, email: // Giovanna Lombardi, email: // Keywords : regulatory T cells, tolerance, immunotherapy, immunosuppression, liver transplantation, Immunology and Microbiology Section, Immune response, Immunity Received : July 26, 2015 Accepted : January 01, 2016 Published : January 17, 2016 Abstract Strategies to prevent organ transplant rejection whilst minimizing long-term immunosuppression are currently under intense investigation with regulatory T cells (Tregs) nearing clinical application. The clinical trial, ThRIL, recently commenced at King’s College London, proposes to use Treg cell therapy to induce tolerance in liver transplant recipients, the success of which has the potential to revolutionize the management of these patients and enable a future of drug-free transplants. This is the first report of the manufacture of clinical grade Tregs from prospective liver transplant recipients via a CliniMACS-based GMP isolation technique and expanded using anti-CD3/CD28 beads, IL-2 and rapamycin. We report the enrichment of a pure, stable population of Tregs (>95% CD4 + CD25 + FOXP3 + ), reaching adequate numbers for their clinical application. Our protocol proved successful in, influencing the expansion of superior functional Tregs, as compared to freshly isolated cells, whilst also preventing their conversion to Th17 cells under pro-inflammatory conditions. We conclude with the manufacture of the final Treg product in the clinical research facility (CRF), a prerequisite for the clinical application of these cells. The data presented in this manuscript together with the much-anticipated clinical results from ThRIL, will undoubtedly inform the improved management of the liver transplant recipient.

Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is integrated treatment versus harm reduction. For years, these two divergent strategies have been considered to be opposite poles of different philosophies of intervention. One is bound to the search for methods that aim to lead the subject to complete abstinence; the other prioritizes a progressive decline in substance use, with maximum reduction in the damage that is correlated with curtailing that use. Reduction of alcohol intake does not require any particular setting, but does require close collaboration between the general practitioner, specialized services for addiction, alcohology services and psychiatry. In patients who reach that target, significant savings in terms of health and social costs can be achieved. Harm reduction is a desirable target, even from an economic point of view. At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, by attempting to remove the shadows of social judgment that, at present, are aiming for a course of treatment that is directed towards absolute abstention.

Introduction and Aims Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms. Design and Methods We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the ‘alcohol syndrome’) in the New South Wales, Australia, automatic syndromic surveillance system. The sample was selected from 68 public hospitals during 2014. Nursing triage free‐text fields were independently reviewed to confirm alcohol consumption and classify each presentation into either an ‘acute’ or ‘chronic’ harm. Positive predictive value (PPV) for acute harm was calculated, and predictors of acute harm presentations were estimated using logistic regression. Results The PPV of the alcohol syndrome for acute alcohol harm was 53.5%. Independent predictors of acute harm were ambulance arrival [adjusted odds ratio (aOR) = 3.4, 95% confidence interval (CI) 2.4–4.7], younger age (12–24 vs. 25–39 years: aOR = 3.4, 95% CI 2.2–5.3), not being admitted (aOR 2.2, 95% CI 1.5–3.2) and arriving between 10 pm and 5.59 am (aOR 2.1, 95% CI 1.5–2.8). PPV among 12 to 24‐year‐olds was 82%. Discussion and Conclusions The alcohol syndrome provides moderate precision as an indicator of acute alcohol harms presenting to the ED. Precision for monitoring acute harm in the population is improved by filtering the syndrome by the strongest independent predictors of acute alcohol harm presentations. [Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis‐based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016;35:693–701]

Purpose Associations between low socio-economic class and alcohol use disorders are relatively well established in developed countries; however, there is comparably little research in India and other developing countries on the associations between socio-economic class, drinking patterns, and alcohol-related problems. We sought to assess drinking patterns and adverse outcomes among male drinkers and examine whether the association between drinking patterns and adverse outcomes differ by socioeconomic class. Methods Population survey of 732 male drinkers screened from 1,899 men, aged 18 to 49 years, randomly selected from rural and urban communities in northern Goa, India. Results Usual quantity of alcohol consumed by 14.8 % (rural 16.8 %; urban 13.6 %) current drinkers is at high-risk level. About 28.6 % (rural 31 %; urban 27.2 %) and 33.7 % (rural 30.5 %; urban 35.5 %) of current drinkers reported monthly or more frequent heavy episodic drinking and drunkenness, respectively. Lower education and lower standard of living (SLI) were associated with higher usual quantity of alcohol consumption. More frequent heavy episodic drinking was associated with older age, being separated, lower education, and lower standard of living; weekly or more frequent drunkenness was associated only with rural residence. All three risky drinking patterns were associated with common mental disorders, sexual risk, intimate partner violence, acute alcohol-related consequences, and alcohol dependence. Significant interactions between SLI and risky alcohol use patterns suggested an increased risk of intimate partner violence among men with risky drinking and lower SLI. Conclusions Risky drinking patterns are common among male drinkers in Goa and associated with lower socio-economic class. A range of adverse health and social outcomes were associated with risky drinking across all socio-economic classes. Alcohol policy should target risky drinking patterns, particularly among poorer men, to reduce the health and social burden of alcohol use in India.

Background: Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective: Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods: Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results: Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions: Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes. [J Med Internet Res 2015;17(8):e201]

Background: Social networks are common in digital health. A new stream of research is beginning to investigate the mechanisms of digital health social networks (DHSNs), how they are structured, how they function, and how their growth can be nurtured and managed. DHSNs increase in value when additional content is added, and the structure of networks may resemble the characteristics of power laws. Power laws are contrary to traditional Gaussian averages in that they demonstrate correlated phenomena. Objectives: The objective of this study is to investigate whether the distribution frequency in four DHSNs can be characterized as following a power law. A second objective is to describe the method used to determine the comparison. Methods: Data from four DHSNs—Alcohol Help Center (AHC), Depression Center (DC), Panic Center (PC), and Stop Smoking Center (SSC)—were compared to power law distributions. To assist future researchers and managers, the 5-step methodology used to analyze and compare datasets is described. Results: All four DHSNs were found to have right-skewed distributions, indicating the data were not normally distributed. When power trend lines were added to each frequency distribution, R 2 values indicated that, to a very high degree, the variance in post frequencies can be explained by actor rank (AHC .962, DC .975, PC .969, SSC .95). Spearman correlations provided further indication of the strength and statistical significance of the relationship (AHC .987. DC .967, PC .983, SSC .993, P

Introduction In April 2011 the NI public health agency estimated that alcohol misuse generates overall annual healthcare costs of £122.2m. There is currently a paucity of data regarding the burden of alcohol-related fractures on the provinces Trauma and Orthopaedic service. Patients and Methods A retrospective review of 104 patients over a 12 month period was performed. Data collected using the Fractures Outcomes and Research Database included: age, gender, smoking status, weekly alcohol intake, mechanism of injury and subsequent treatment. Results Alcohol related fractures accounted for 6.1% of all acute fractures admissions in the 12 month period. 73% were male, with a bimodal age distribution. The majority of patients were classed as social drinkers; however a significant proportion (23.1%) were alcohol dependent. 62.5% of patients were smokers at the time of admission. 95% of patients suffered a single injury which was commonly secondary to a simple mechanical fall (53.8%). The majority of patients sustained lower limb injuries, with 30.8% of these being ankle fractures. Conclusion In conclusion, our study has identified that alcohol-related trauma creates a significant financial burden on the NHS. It is likely that the incidence of alcohol related fracture is higher than documented in this study. We advocate the assessment of patients using the AUDIT-C score to assess for at risk drinking behaviour in those presenting with an alcohol related fracture.