Alcohol Accelerates Aging of Brain’s Frontal Cortex

MedicalResearch.com Interview with:
alcohol-cdc-image
Edith V. Sullivan, Ph.D.
Professor
Department of Psychiatry & Behavioral Sciences
Stanford University School of Medicine
Stanford, CA 94305-5723 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Alcohol misuse is a major public health problem worldwide with profound health consequences on the body, brain, and function. Our research group has conducted naturalistic yet controlled studies of alcohol dependence for several decades to further our understanding of when and how alcohol misuse affects specific parts of the brain.  In addition, we wanted to know how alcohol misuse interacts with the typical changes in the brain as we grow older.  The studies are controlled in that we recruit healthy, non-alcohol dependence men and women from the community to undergo the same screening and neuroimaging procedures as our alcoholic recruits.  The studies are quantitative because we use neuroimaging methods (Magnetic Resonance Imaging) that enable us to measure specific regions of brain structural volumes.  Consistent collection of such data over the years positioned us to ask whether age and alcohol dependence interact to produce regional brain volume loss beyond the loss that occurs in normal aging.

A number of cross-sectional studies pointed to the likelihood that the effects of alcohol dependence on brain structure would be exacerbated by normal aging, which we do know from longitudinal neuroimaging studies results in shrinkage of cortical gray matter volume and thinning of the cortex. What was particularly striking about our longitudinal study of men and women with alcohol dependence was the acceleration of the aging of brain structure that was especially prominent in the frontal cortex.  Critically, even those who initiated dependent drinking at an older age showed accelerated loss.

Because our study sample was large enough, we could also test whether our findings were attributable to conditions that commonly co-occur with alcohol dependence, namely, illicit drug use and hepatitis C.  Although both drug use and hepatitis C infection may have exacerbated brain volume loss, these factors did not fully account for the alcoholism-aging interaction we identified.

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What is the Biggest Modifiable Risk Factor For Dementia? Alcohol

MedicalResearch.com Interview with:
“undefined” by Iñaki Queralt is licensed under CC BY 2.0Michaël Schwarzinger, MD, PhD

Translational Health Economics Network (THEN)
Paris

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The association of heavy drinking with dementia has been known for decades. For instance, there is about no Wernicke–Korsakoff syndrome without heavy drinking and the syndrome was described in 1890. But this type of dementia is very rare. Also, heavy drinking is knowingly associated with multiple risk factors for dementia onset such as hypertension or diabetes. But heavy drinkers generally refuse to participate to cohort studies and declaration of alcohol use among participants is generally biased downward… So the study rationale is very strong, but supporting empirical evidence is quite scarce.

This nationwide study included all 31+ million adults discharged from hospitals over 6 years, i.e., 50% of the French population before 65 years old and 80% above that age. Of 1.1+ million adults diagnosed with dementia, one in twenty had an early-onset (before 65 years old). Heavy drinking was recorded in most (56%) early-onset dementia cases: two-third in men; one-third in women. In addition, the association of heavy drinking with dementia goes far beyond 65 years old, both directly (>3 times higher risk for dementia onset after controlling for more than 30 known risk factors for dementia) and indirectly as heavy drinking was associated with all other independent risk factors for dementia onset. Accordingly, heavy drinking had the largest effect on dementia risk of all independent modifiable risk factors such as hypertension or diabetes.

The effects were found whatever dementia case definition or population studies.

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Alcohol Doesn’t Cause Aggression By Simple Disinhibition

MedicalResearch.com Interview with:
“Alcohol” by zeevveez is licensed under CC BY 2.0Thomas Denson PhD

University of New South Wales
Australia 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Decades of research have shown that alcohol is a powerful psychotropic contributor to aggressive behaviour. Researchers have long suspected that alcohol increases aggression because it dampens activation in the prefrontal cortex, which leads to reduced inhibition, narrows attentional processing, and exaggerates hostile thinking. However, direct evidence has been lacking. We compared brain activity in intoxicated versus sober participants when they were given the opportunity to behave aggressively in the scanner against other men who provoked them.

We gave 50 healthy young men alcohol or a placebo. Participants who consumed alcohol breathalysed at .05. They did show decreased activation in the prefrontal cortex as expected. This was the first evidence to show that when intoxicated participants behave aggressively, they show reduced prefrontal activity. Interestingly, we found a positively correlation between prefrontal cortex activity and aggression, but only among intoxicated men. We think this reflects the fact that the participants in the alcohol condition were likely engaging in more hostile thinking about the provoking men.  Continue reading

Why Do Persons With Alcohol Use Disorder Not Adhere To Naltrexone Treatment?

MedicalResearch.com Interview with:
“Alcohol” by zeevveez is licensed under CC BY 2.0Sarah Dermody PhD

Assistant professor
School of Psychological Science
College of Liberal Art
Oregon State University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Naltrexone is an FDA-approved medication to treat alcohol use disorder. We know that people have difficulty adhering to the prescribed daily medication regimen, and that people who do not adhere to the medication tend not to fair as well in treatment as people who take the medication regularly.

This particular study attempted to address the question of why do people with alcohol use disorder have difficulty taking the medication daily? What we found was that people were less likely to take naltrexone after days of heavy drinking or strong alcohol craving versus typical drinking and craving levels. Furthermore, individuals were less likely to take the medication on weekends versus weekdays, which is particularly worrisome because heaviest drinking episodes tend to happen on the weekends.

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Most Attempts At Reducing Alcohol Consumption Fail

MedicalResearch.com Interview with:
“Alcohol Poisoning PSA Video Shoot” by Stop Alcohol Deaths, Inc. is licensed under CC BY 2.0Dr. Frank de Vocht

Senior Lecturer in Epidemiology and Public Health Research
Academic Lead Year 1 MBChB (MB21) ‘Foundations of Medicine’ Programme
Population Health Sciences
Bristol Medical School
University of Bristol 


MedicalResearch.com: What is the background for this study?

Response: We were interested in prospectively investigating whether people who drink alcohol in the general population (so not patients), and who indicated that the were planning to reduce their consumption or complete stop drinking in the near future would, on average, succeed and have reduced consumption six months later.  Continue reading

Children with ADHD Found To Abuse Drugs and Alcohol At Early Age

MedicalResearch.com Interview with:

Brooke S. G. S Molina, PhD Professor of Psychiatry, Psychology and Pediatrics University of Pittsburgh 

Dr. Molina

Brooke S. G. S Molina, PhD
Professor of Psychiatry, Psychology and Pediatrics
University of Pittsburgh 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been inconsistency across previous studies of children with ADHD and their risk of substance use in adolescence and in adulthood. This study closely examined substance use by children with and without ADHD over a long period of time, considering that experimenting with some substances, such as alcohol and cigarettes, is typical after teens reach high-school age.

This study found that children with attention deficit hyperactivity disorder (ADHD) engaged in substance use at a younger age than those without ADHD and had a significantly higher prevalence of regular marijuana and cigarette use into adulthood.

We also found that children diagnosed with ADHD had a faster progression of substance use during childhood and adolescence.

We confirmed a finding for the ADHD group that is widely replicated in the general population – that early substance use strongly predicts adult substance use.  However, more of the children with ADHD were found to be early substance users, such as having a drink of alcohol before the age of 15.

We did not find higher rates of binge alcohol consumption among young adults with ADHD.  However, alcohol use is still an important part of the bigger picture.

The amount of alcohol consumption was self-reported in a questionnaire where the average age of all participants was 25. Binge drinking is very common in early adulthood, but given our findings of children with ADHD starting to drink at younger ages, it’s important to continue this research so we know how many young drinkers with ADHD continue to have serious, chronic problems with drinking as they age.

MedicalResearch.com: What should readers take away from your report?

Response: It’s very important to understand from our findings that substance abuse begins at a young age – often before high school.  Parents and providers need to understand this and continually assess risk.

We are concerned about the long-term consequences of these substance use patterns.  We do not know how many of these individuals will experience painful and expensive middle age outcomes of chronic substance abuse and associated problems such as divorce, employment problems, injuries, poor health and shortened life expectancy.  Some will be resilient and decrease their substance use.  We need to learn what predicts these outcomes. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The marijuana use finding is also concerning given the increasing availability of cannabis in the United States and the risk and consequences for children with ADHD needs further study. 

MedicalResearch.com: Is there anything else you would like to add?

Response: These results suggest a crucial need for routine clinical practice to include early screening and interventions to prevent early substance use, including cigarette smoking, among children with ADHD.

Many children with ADHD end up being cared for in primary care settings, so pediatricians are the front-line treatment care providers and conversations about substance use need to begin early. When children with ADHD are being treated, we need to start monitoring their potential risk for substance use at a young age, and not only treating with medication, but considering the range of factors that increase their risk for becoming dependent on nicotine and for developing substance use disorders. 

Citations:

J Child Psychol Psychiatry. 2018 Jan 8. doi: 10.1111/jcpp.12855. [Epub ahead of print]

Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study.

Molina BSG1, Howard AL2, Swanson JM3, Stehli A3, Mitchell JT4, Kennedy TM5, Epstein JN6, Arnold LE7, Hechtman L8, Vitiello B9, Hoza B10. 

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Alcohol-Harm Paradox Linked To Drinking Patterns

MedicalResearch.com Interview with:
“Alcohol” by Jorge Mejía peralta is licensed under CC BY 2.0Dr. Eirik Degerud, PhD

Norwegian Institute of Public Health

MedicalResearch.com: What is the background for this study?

Response: Alcohol-related hospitalisations and deaths are more frequent among individuals with low socioeconomic position, despite that they tend to drink less on average. This is referred to as the alcohol-harm paradox. Alcohol is associated with both higher and lower risk of cardiovascular disease, depending on the drinking pattern. We wanted to assess if the paradox was relevant to these relationship also. Continue reading

Weight Loss Procedures Can Double Blood Alcohol Absorption

MedicalResearch.com Interview with:

“Alcohol” by Takahiro Yamagiwa is licensed under CC BY 2.0


Marta Yanina Pepino PhD

Department of Food Science and Human Nutrition
College of Agricultural, Consumer and Environmental Sciences
University of Illinois
Urbana, IL 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is not the first to look at whether sleeve gastrectomy affects alcohol absorption and metabolism. Before our study, there were three published studies in the literature on this issue. However, findings from these studies were discrepant. Two of the studies found that sleeve gastrectomy did not affect blood alcohol levels and one of the studies did found that peak blood alcohol levels were higher when people drink after having a sleeve gastrectomy. All these three studies used a breathalyzer to estimate blood alcohol levels.

Our study tested the following two related hypothesis.

First, that similar to Roux-en-Y- gastric bypass (RYGB), sleeve gastrectomy accelerates alcohol absorption, which cause peak blood alcohol levels to be higher and much faster than before surgery. Because the breathalyzer requires a 15 min of waiting time between drinking the last sip of alcohol and the time that you can read a good estimate of blood alcohol levels from the breath, we hypothesized that the breathalyzer was not a good technique to estimate peak blood alcohol levels in people who may reach a peak blood alcohol level before those 15 min have passed, such as people who underwent sleeve gastrectomy or RYGB.

We found these two hypothesis to be truth:

1) Sleeve gastrectomy, similar to RYGB, can double blood alcohol levels; and

2) The breathalyzer technique is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol (it underestimate blood alcohol levels by ~27% and it may miss peak blood alcohol levels).

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Aldosterone-Mineralocorticoid Pathway Linked To Craving For Alcohol

MedicalResearch.com Interview with:

Lorenzo Leggio, M.D., Ph.D. Chief of the Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, a NIAAA intramural laboratory 

Dr. Leggio

Lorenzo Leggio, M.D., Ph.D.
Chief of the Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, a NIAAA intramural laboratory

MedicalResearch.com: What is the background for this study?

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aldosterone is an important hormone involved in the control of blood pressure and electrolytes via its mineralcorticoid receptor (MR). In addition to its roles in the periphery in our body, aldosterone also acts on the brain where the MR is particularly present in regions like the amygdala. The amygdala plays an important role in stress, anxiety and excessive alcohol drinking. Back in 2008, we conducted a small pilot study where we found that alcohol-dependent patients with higher blood aldosterone concentrations have higher alcohol craving.

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Pot Plus Alcohol Raises Fatal Traffic Accident Risk Over 500%

MedicalResearch.com Interview with:

Guohua Li DrPH, MD Professor and Director Center for Injury Epidemiology and Prevention Department of Epidemiology Mailman School of Public Health Columbia University

Dr. Li

Guohua Li DrPH, MD
Professor and Director
Center for Injury Epidemiology and Prevention
Department of Epidemiology
Mailman School of Public Health
Columbia University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Drugged driving has become a serious problem in the United States in the recent years due to increased consumption of marijuana and opioids. About 20% of fatally injured drivers used two or more substances, with alcohol-marijuana being the most commonly detected polydrug combination.

Our study of over 14000 fatal 2-car crashes indicates that drivers testing positive for alcohol, marijuana, or both are significantly more likely to be responsible for initiating these crashes than those using neither of the substances. Specifically, compared to drivers not using alcohol and marijuana, the risk of being responsible for initiating fatal crashes increases 62% for those testing positive for marijuana and negative for alcohol, 437% for those testing positive for alcohol and negative for marijuana, and 539% for those testing positive for both alcohol and marijuana. These results suggest that when used in combination, alcohol and marijuana have a positive interaction on the risk of fatal crash initiation.

The most common driver error leading to fatal 2-car crashes is failure to keep in proper lane, followed by failure to yield right of way and speeding.

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